Background The number of adult heart transplant candidates waiting at the most urgent status 1A has increased over time despite the expansion of geographic sharing of hearts in 2006. We aimed to determine whether candidates listed with inotropes contribute to the excess status 1A candidates.

Methods and Results The initial registrations of all adult heart-only candidates listed from 2000 to 2015 were analyzed using the Scientific Registry of Transplant Recipients data set. Trends in listing status, justifications, and candidate factors were measured. Adjusted trends in listing status pre- and post–geographic sharing were estimated using multilevel logistic regression. Competing risks models provided trends in transplant-free waitlist survival. There were 46 853 adult heart-alone listings during 2000 to 2015. Pre-sharing, status 1A listing was unchanged over time (adjusted odds ratio, 0.98; 95% confidence interval, 0.78–1.23). Post-sharing, the adjusted odds of status 1A listing increased 117% over 9 years (adjusted odds ratio 2.17, 95% confidence interval, 1.82–2.58). The number of candidates listed as status 1A with inotropes increased by 193 a year, whereas the dobutamine, dopamine, and milrinone doses used decreased 49%, 55%, and 29% (P<0.001). The risk of waitlist death or deterioration of status 1A inotrope candidates relative to status 2 candidates decreased 62% for 2006 to 2010 and 70% for 2011 to 2015 compared with that for 2003 to 2006.

Conclusions After the wider geographic sharing of hearts in 2006, transplant programs used multiple inotropes to list candidates at status 1A more frequently with progressively lower doses. Concurrently, the status 1A inotrope candidate waitlist outcomes improved substantially. These trends suggest that overtreatment with multiple inotropes contributes to the current critical excess of status 1A candidates.

背景技术尽管2006年心脏的地理共享有所扩大，但等待最紧急状态1A的成年心脏移植候选人的数量却随着时间的推移而增加。我们旨在确定列有正性肌力药物的候选人是否对过剩状态1A候选人有所贡献。

方法与结果使用“移植收件人科学注册”数据集，分析了2000年至2015年列出的所有仅心脏专科成年候选人的初始注册信息。测量了上市状态，理由和候选因素的趋势。使用多级Logistic回归估计了上市前和上市后地理共享状态的调整趋势。竞争风险模型提供了无移植候补名单生存的趋势。在2000年至2015年期间，有46 ​​853个成人独立心脏上市。在共享前，状态1A上市在一段时间内没有变化（调整后的优势比为0.98； 95％的置信区间为0.78-1.23）。共享后，状态1A列表在9年内的调整后赔率增加了117％（调整后赔率比2.17，95％置信区间1.82-2.58）。被列为1A状态且具有正性肌力的候选人的数量每年增加193，P <0.001）。与2003年至2006年相比，2006年至2010年候补名单中状态1A候选者相对于状态2候选者死亡或恶化的风险降低了62％，2011年至2015年降低了70％。

结论在2006年扩大了心脏的地域共享范围之后，移植程序使用了多种正性肌力药物，以逐渐降低剂量的方式更频繁地列出处于1A状态的候选者。同时，状态为1A的铁定型候选候补结果得到了显着改善。这些趋势表明，使用多种正性肌力药物过度治疗会导致当前严重超过状态1A的候选人。