Abstract 14072: Heart Retransplantation Under the 2018 Adult Heart Allocation Policy

Abstract

Introduction: The new adult heart allocation policy was implemented on October 18, 2018. The purpose of the present study was to characterize the impact of this policy change on waitlist and post-transplant outcomes of heart retransplantation in the United States. Methods: All adults listed for heart retransplantation from May 2015 to March 2022 were identified using the United Network for Organ Sharing database. Patients were stratified into equal time eras (pre- and post-policy) based on the heart allocation change on October 18, 2018. Competing risks regressions were used to determine differences in waitlist outcomes, including waitlist death or deterioration and retransplantation rates following listing. Kaplan-Meier survival estimates were used to assess differences in 1-year post-transplant survival between eras. Results: Overall, 672 heart transplant candidates were included in analysis, with 49% listed during post-policy. Retransplantation candidates listed during post-policy were of similar age (45 vs 47 years, P=0.11) and female gender (33% vs 34%, P =0.70) compared to pre-policy candidates. Post-policy candidates had a shorter median waitlist duration (51 days vs 80 days, P<0.01), along with a lower likelihood of death or deterioration on the waitlist (subdistribution hazard ratio, SHR 0.45, 95% CI 0.27-0.74) and higher likelihood of retransplantation within 30 days of listing (SHR 2.65, 95% CI 1.86-3.80) compared to pre-policy (Figure). Among those retransplanted, pre-policy recipients experienced similar rates of 30-day post-transplant mortality (6.9% vs 6.7%, P=1.00) and 1-year post-transplant survival (82% vs 87%, P=0.24). Conclusions: Heart retransplantation candidates have experienced improved waitlist outcomes following the 2018 adult heart allocation policy without significant changes to post-transplant survival. Continued monitoring for long-term outcomes is warranted in this patient population.