Insights Into the Revision of Heart Transplant Allocation Criteria ― Analysis of Waitlist Mortality and Transplant Probability for Adult Heart Transplant Candidates in the Nationwide Registry Data of Japan ―
Abstract
BACKGROUND: Using the Japan Organ Transplant Network national waitlist, this study investigated confounding factors for waitlist mortality and transplant probability among adult heart transplant candidates, focusing on heart disease and change in status (from registration to observation on June 30, 2024), to provide insights into the use of underlying heart disease or severity in the current revision of the heart transplant allocation criteria. METHODS AND RESULTS: All-cause waitlist mortality and heart transplantation probability were assessed using Gray's test, as well as univariate and multivariate Fine-Gray subdistribution hazard regression models. After excluding heart-lung transplantation candidates, patients with missing data, patients who were never on the waitlist after revision of the Organ Transplant Act, and patients aged <18 and ≥60 years at the time of registration, 1,522 patients were included in the final cohort. Heart transplant candidates with congenital heart disease had a higher risk of mortality, whereas patients waiting for retransplantation had no chance of transplantation and all died. The mortality rate was significantly higher for patients listed as Status 2 (unchanged) at observation than those listed as Status 1 (unchanged). CONCLUSIONS: Prioritization of candidates with congenital heart disease should be considered to reduce the risk of mortality while patients are on the transplant waitlist.
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BibTeX
@article{ashikari2026insights,
title = {{Insights Into the Revision of Heart Transplant Allocation Criteria ― Analysis of Waitlist Mortality and Transplant Probability for Adult Heart Transplant Candidates in the Nationwide Registry Data of Japan ―}},
author = {Juntaro Ashikari and Yasumasa Tsukamoto and Shinichi Nunoda and Yusuke Takemura and Junya Mita and Goro Matsumiya and Tomoyuki Fujita and Koichiro Kinugawa and Takeshi Nakatani and Yoshiki Sawa},
journal = {Circulation Journal},
year = {2026},
month = oct,
doi = {10.1253/circj.cj-25-0939},
url = {https://www.jstage.jst.go.jp/article/circj/90/11/90_CJ-25-0939/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Insights Into the Revision of Heart Transplant Allocation Criteria ― Analysis of Waitlist Mortality and Transplant Probability for Adult Heart Transplant Candidates in the Nationwide Registry Data of Japan ―
AU - Juntaro Ashikari
AU - Yasumasa Tsukamoto
AU - Shinichi Nunoda
AU - Yusuke Takemura
AU - Junya Mita
AU - Goro Matsumiya
AU - Tomoyuki Fujita
AU - Koichiro Kinugawa
AU - Takeshi Nakatani
AU - Yoshiki Sawa
PY - 2026
DA - 2026/10/23
JO - Circulation Journal
DO - 10.1253/circj.cj-25-0939
UR - https://www.jstage.jst.go.jp/article/circj/90/11/90_CJ-25-0939/_article
AB - BACKGROUND: Using the Japan Organ Transplant Network national waitlist, this study investigated confounding factors for waitlist mortality and transplant probability among adult heart transplant candidates, focusing on heart disease and change in status (from registration to observation on June 30, 2024), to provide insights into the use of underlying heart disease or severity in the current revision of the heart transplant allocation criteria. METHODS AND RESULTS: All-cause waitlist mortality and heart transplantation probability were assessed using Gray's test, as well as univariate and multivariate Fine-Gray subdistribution hazard regression models. After excluding heart-lung transplantation candidates, patients with missing data, patients who were never on the waitlist after revision of the Organ Transplant Act, and patients aged <18 and ≥60 years at the time of registration, 1,522 patients were included in the final cohort. Heart transplant candidates with congenital heart disease had a higher risk of mortality, whereas patients waiting for retransplantation had no chance of transplantation and all died. The mortality rate was significantly higher for patients listed as Status 2 (unchanged) at observation than those listed as Status 1 (unchanged). CONCLUSIONS: Prioritization of candidates with congenital heart disease should be considered to reduce the risk of mortality while patients are on the transplant waitlist.
SN - 1347-4820
SN - 1346-9843
ER -