Comparison of Sixth-Month Post-Transplant Survival before and after Implementation of the 2018 UNOS Allocation Policy Change in Patients with Restrictive Cardiomyopathy

Abstract

<h3>Purpose</h3> The intent of the UNOS allocation system change was to better prioritize heart transplantation (HT) for the most critically ill patients. Here, we explore six-month post-transplant survival of HT patients with a pre-transplant diagnosis of restrictive cardiomyopathy one year before (PRE) and after (POST) the allocation change (10/18/2018). <h3>Methods</h3> We identified all adult patients (N=205) with RCM that underwent HT between 10/18/2017 to 10/17/2019. There were 93 patients in the PRE group and 112 patients in the POST group. Baseline clinical characteristics were compared using Mann-Whitney U test and Chi-square test as appropriate. Survival analysis was performed using Kaplan-Meier (KM) analysis and both Univariate and Multivariate Cox Proportional Hazards (PH) regression analysis adjusted for policy change, recipient age, donor age, gender mismatch, bilirubin, creatinine, dialysis status, ischemic time, and ventilator use. <h3>Results</h3> There was no significant difference in 6-month survival between the groups by KM analysis (p=0.58). Policy change was not a significant predictor of mortality by univariate analysis (HR 1.29 [0.53, 3.15]) and multivariate analysis (HR 1.8 [0.67,4.81]). Median ischemic time (3.6 hrs vs. 2.8 hrs, p <0.001), distance (271.0 nmi vs. 74 nmi, p <0.001), and time on waitlist (22.5 days vs. 39.0 days, p=0.008) were greater in the POST era. Otherwise, there was no significant difference in baseline characteristics. Notably, multivariate analysis showed that donor age (HR 1.04 [1.00, 1.09]) and creatinine (HR 3.03 [1.24, 6.84]) were associated with increased mortality in the POST group. <h3>Conclusion</h3> The 2018 policy change did not affect 6-month post-transplant survival or mortality for patients with RCM.