Impact of the 2018 Allocation Criteria Change on Outcomes Following Cardiac Retransplantation within 30 Days: Analysis of the United Network for Organ Sharing Database.

Authors

• Jason M. Aubrey, Corewell Health West Resident
• Melonie Abravanel, Michigan State University College of Human Medicine Medical Student
• Nabin Manandhar Shrestha, Corewell Health West
• Renzo Y. Loyaga-Rendon, Corewell Health West
• Sangjin Lee, Corewell Health West
• Scott R. Chicotka, Corewell Health West
• Robert L. Hooker, Corewell Health West

Document Type

Article

Publication Date

4-2026

Publication Title

JHLT Open

Abstract

INTRODUCTION: Early retransplantation following initial orthotopic heart transplantation (OHT) is a rare occurrence, with early evidence suggesting unfavorable clinical outcomes. In October 2018, the United Network for Organ Sharing (UNOS) implemented the current 6-tier heart allocation system, prioritizing critically ill patients on temporary mechanical support. The impact of this policy change on early retransplantation remains unclear.

METHODS: We performed a retrospective cohort study using the UNOS database to identify adult patients who underwent cardiac retransplantation within 30 days of their initial OHT between 2014 and 2023. Patients were stratified by the allocation era into two 5-year periods: prior (pre-October 2018) and current (post-October 2018) era. Clinical variables were compared at both the initial and retransplant timepoints. The primary outcome was 1-year survival following retransplantation.

RESULTS: Fifty-nine patients met the inclusion criteria, 17 (28.8%) retransplanted in the prior era and 42 (71.2%) in the current era. There were significantly more early retransplanted patients in the current era (42 (0.27%) vs 17 (0.14%),

CONCLUSIONS: Early cardiac retransplantation is performed in patients with very high acuity and is associated with poor outcomes. Since the 2018 allocation policy change, early retransplantation has become increasingly common, but the outcomes remain very poor with approximately 50% of them not surviving to the first year. These findings highlight important ethical considerations regarding organ allocation and candidate selection when considering early retransplantation.

Volume

13

First Page

100571

Last Page

100571

Recommended Citation

Aubrey JM, Abravanel M, Shrestha NM, Loyaga-Rendon RY, Lee S, Chicotka SR, et al. [Hooker RL, Jr]. Impact of the 2018 allocation criteria change on outcomes following cardiac retransplantation within 30 days: Analysis of the United Network for Organ Sharing database. JHLT Open. 2026;13:100571. doi: 10.1016/j.jhlto.2026.100571. PMID: 42165085.

Comments

Frederik Meijer Heart and Vascular Institute

DOI

10.1016/j.jhlto.2026.100571

ISSN

2950-1334

PubMed ID

42165085