Trends in Wait–List Mortality in Children Listed for Heart Transplantation in the United States: Era Effect Across Racial/Ethnic Groups

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We sought to evaluate trends in overall and race–specific pediatric heart transplant (HT) wait–list mortality in the United States (US) during the last 20 years. We identified all children <18 years old listed for primary HT in the US during 1989–2009 (N = 8096, 62% White, 19% Black, 13% Hispanic and 6% Other) using the Organ Procurement and Transplant Network database. Wait–list mortality was assessed in four successive eras (1989–1994, 1995–1999, 2000–2004 and 2005–2009). Overall wait–list mortality declined in successive eras (26%, 23%, 18% and 13%, respectively). The decline across eras remained significant in adjusted analysis (hazard ratio [HR] 0.70 in successive eras, 95% confidence interval [CI], 0.67–0.74) and was 67% lower for children listed during 2005–2009 versus those listed during 1989–1994 (HR 0.33; CI, 0.28–0.39). In models stratified by race, wait–list mortality decreased in all racial groups in successive eras. In models stratified by era, minority children were not at higher risk of wait–list mortality in the most recent era. We conclude that the risk of wait–list mortality among US children listed for HT has decreased by two–thirds during the last 20 years. Racial gaps in wait–list mortality present variably in the past are not present in the current era.

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