Abstract
BackgroundPatients with blood group O have historically been disadvantaged in the United Network for Organ Sharing (UNOS) heart transplant allocation system. We sought to determine whether the new UNOS allocation system implemented in 2018 had an impact on waitlist and postâtransplant outcomes among blood groups.MethodsUsing the UNOS database we included all adult patients listed and transplanted with firstâtime singleâorgan heart transplant between 10/17/15 and 10/1/21. For postâtransplant outcomes, we separately evaluated all adult patients transplanted with the same timeâframe. We used exclusion criteria and censoring to limit biases from changing clinical practices around the allocation change (10/18/2018), and from unequal or inadequate followâup. We compared clinical characteristics and outcomes before and after the allocation change among each blood group. FineâGray and Cox regression models were used to estimate the effect of the new allocation system on competing waitlist outcomesâ transplantation, deathâorâremoval from waitlistâ and postâtransplant survival, respectively.ResultsOf the 21,565 patients listed for transplantation 14,000 met criteria for waitlist analysis (7,035 in the old system vs. 6,965 in the new), and 7,657 met criteria for postâtransplant analysis (3,519 in the old system vs. 4,138 in the new). Among each blood group, new allocation change was associated with higher transplantation rates lower waitlist days and lower waitlist mortality (except Group AB). However, despite improvements, Group O was still associated with worse waitlist outcomes for each metric compared to nonâO Groups. The new allocation system did not have a significant impact on postâtransplant survival among any blood groups.ConclusionChanges in heart transplant allocation have attenuated but not eliminated blood group O disadvantage in access to donor hearts.
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