Abstract 15677: Heart Transplant in Older Adults: Before and After the 2018 United Network for Organ Sharing Allocation Change

Abstract

Introduction: There is an increasing trend towards transplanting older adults, and the proportion of those over 70 who have been transplanted has increased in recent years. In 2018, the United Network for Organ Sharing (UNOS) implemented a 6-tier allocation policy to replace the prior 3-tier system. There have been significant shifts in cardiac transplantation practices and patient outcomes following the implementation of the new policy. Hypothesis: This study aims to evaluate the impact of the new allocation policy on older adults. Methods: Adult patients who received heart transplant between January 1, 2010 and December 31, 2021 were identified in the UNOS registry and stratified by whether they were transplanted pre-2018 or post-2018. Outcome of interest was mortality at 1 after heart transplant. Multivariable Cox proportional hazard modeling was used to estimate hazard ratios associated with outcomes of interest. Results: 661 patients over the age of 70 were transplanted pre-2018 and 413 patients over 70 were transplanted post-2018. Those who were transplanted after the 2018 UNOS allocation change were less likely to have had an ischemic cardiomyopathy, more likely to have had an IABP or be on ECMO prior to transplant, and more likely to have had cancer prior to transplant. There was no difference in rates of diabetes, prior CVA, and dialysis for those transplanted pre- vs post-2018. 1 Year mortality for those pre- and post-2018 were similar (10.4% pre-2018, 11.4% post-2018, HR 1.11, CI 0.77-1.61, p=0.6). Conclusions: There has not been a change in mortality in older adults with the 2018 UNOS allocation change. The increase in usage of IABP and ECMO prior to transplant post-2018 mirror changes in the overall population. Notably, post-2018, more older adults with prior malignancies are being transplanted.