Abstract 13828: Improvement in Racial Disparities in Heart Transplantation Following the Heart Allocation Policy Change

Abstract

Objectives Heart allocation policy (HAP) in the US was changed in October 2018. The aim of this study was to assess the effect of the new policy on racial disparities in heart transplantation (HT) outcomes. Methods: The United Network for Organ Sharing (UNOS) registry was used to identify adult patients undergoing isolated HT between 2010-2021. Patients were stratified into pre-HAP (January 2010 to September 2018) vs. post-HAP (October 2018 to September 2021). Recipient race was classified as White, Black, Hispanic, or Other. The primary outcome was post-HT mortality. Cox proportional hazard models were used for risk-adjustment in evaluating the independent effect of race on mortality. Results A total of 27,403 patients underwent HT in 143 centers during the study period. The proportion of non-whites undergoing HT increased in the post-HAP era: (pre-HAP: White 66.0%, Black 21.2%, Hispanic 8.2%, Other 4.6% versus post-HAP: White 62.5%, Black 23.2%, Hispanic 9.5%, Other 4.8%; p<0.001). In risk-adjusted analysis, Black recipients were at higher risk of post-HT mortality in the pre-HAP era (HR 1.31, 95% CI 1.22-1.41; p<0.001) but not in the post-HAP era (HR 1.12, 95% CI 0.03-1.34; p=0.222) compared to White recipients. Other non-white recipients had comparable risk-adjusted post-HT mortality rates compared to White recipients both in the pre- and post-HAP eras. Conclusions: Under the new heart allocation system, a higher percentage of recipients are non-white. In addition, racial disparities in outcomes have improved with Black recipients no longer having an increased adjusted risk of mortality following HT.