Impact of the 2018 Donor Heart Allocation System on Post Transplant Morbidity and Mortality

Abstract

Introduction The 2018 revised United Network of Organ Sharing (UNOS) heart transplant (HTx) donor allocation system, initiated on October 18, 2018, aimed to minimize waitlist mortality by prioritizing the transplant of more unstable candidates. However, this prioritization could potentially trade lower waitlist mortality for higher post-transplant morbidity and mortality. The purpose of this study was to examine the impact of the revised HTx allocation system on the clinical characteristics and outcomes of HTx recipients from a high-volume transplant center. Methods We identified 169 adult patients undergoing first-time single-organ HTx between October 2017 and October 2019. The cohort was divided into Era 1 (79 patients; 10/18/17-10/17/18) and Era 2 (90 patients; 10/18/18-10/17/19). Demographic and clinical characteristics, waitlist characteristics, and post-transplant morbidity and mortality were compared between eras. Results Patients in Era 2 were younger (55 v. 61 years, p=0.004), were twice as likely to be transplanted on temporary mechanical circulatory support (44% v. 20%, p Conclusion In a high-volume center, the revised HTx allocation system has shortened HTx waitlist time with transplantation of more unstable patients on temporary mechanical support with no impact on post-transplant outcomes. This suggests that, with careful patient selection, the revised allocation system may optimize both waitlist and post-transplant outcomes.