Disparities in the Outcomes in the Waitlist and after Transplantation According to Transplant Region: Implications for a Future Allocation System.

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

Journal of Cardiac Failure

Abstract

Introduction: The implementation of the current Heart Transplant (HT) allocation system in 2018 led to a significant change in practices in the management of waitlisted patients. The regional impact of the current system has not been evaluated. Our objective was to evaluate the changes in outcomes in the waitlist and after HT with the implementation of the current allocation system according to transplant regions.

Methods: Adult patients who were registered in the UNOS database for heart transplantation between Jan 1, 2014, and Dec 31, were included in the study. Patients listed for re-transplantation or multiorgan transplant were excluded. Patients were classified in the current or prior allocation system using Oct 18, 2018, as a cutoff. The one-year, cumulative incidence (CI) of transplantation, death or delisting due to worsening clinical status, and the post-transplant survival were calculated for each transplant region and compared using Fine-Gray analysis (competing risks) and Kaplan-Meier (post-transplant survival).

Results: A total of 26450 patients were listed for HT during the study period. Of these 15761 and 10689 patients were listed in the prior and current allocation system, respectively. A total of 17796 patients received HT, 9424 in the prior and 8372 in the current allocation system. There were significant variations in the outcomes in the waitlist and post transplantation according to transplant regions and the effect of the implementation of the current (Table 1). In the prior system, regions 3 and 11 had the highest CI of death or delisting (12.5% and 12%) and regions 4 and region 9 had the lowest (8.7% and 8.5%) (p< 0.001). In the new system region 3 had the highest CI of death or delisting (9.5%) whereas region 9 had the lowest 4.5%). Region 1 had the lowest cumulative incidence of transplantation in the prior system (46.6%), whereas region 5 had the highest (63.7%) (p< 0.001), In the current allocation system Region 10 had the lowest cumulative incidence of transplantation (57%), whereas region 5 had the highest (78.7%), (p< 0.001). In the prior system, regions 5 and 6 had the highest 1-year post-transplant survival (93.3% and 93.4%) and region 4 had the lowest (90.9%) (p< 0.001). In the current system region 3 had the lowest survival (89.3%) and regions 5 and 6 the highest (94.2% and 94.1%).

Conclusion: There are significant regional variations in the outcomes in the waitlist and after heart transplantation in the United States. The implementation of the current allocation system has shifted the disparities but not resolved them. These disparities will require careful monitoring if a new continuous allocation system is implemented.

Volume

31

Issue

1

First Page

292

Comments

Heart Failure Society of America (HFSA) Annual Scientific Meeting, September 27-30, 2024, Atlanta, GA

Last Page

292

DOI

10.1016/j.cardfail.2024.10.281

ISSN

1532-8414

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