Trends in Adult Heart Transplantation and Associated Outcomes- Analysis of the Unos Registry

Abstract

Background There is currently limited evidence on temporal trends in outcomes of heart transplantation specific to the U.S., and the impact of change in allocation policy on outcome is largely unknown. Yet, evaluation of outcome trend is imperative to identifying areas of improvement and making goal-directed policies Methods We queried the national database of the United Network of Organ Sharing (UNOS) to identify outcomes of adult heart transplantation that were done in the U.S between 1991 and 2016. Primary outcome was graft survival, including survival to hospital discharge, 1-year survival and 5-year survival. Secondary outcomes included procedure-related stroke, pacemaker implantation, renal failure requiring dialysis, and length of hospitalization stay. We evaluated trend in the outcomes over the study period. In addition, we evaluated for the impact of change in UNOS allocation policy in 2006 on survival trend Results Between 1991 and 2016, a total of 52,783 adult donor hearts were transplanted in the U.S. The annual number increased from 1,907 in 1991 to 2,764 in 2016. Survival to hospital discharge and 1-year survival increased from 89.6% and 82.5% in 1991 to 95.1% and 91.5% in 2016, respectively (p trend Conclusion Between 1991 and 2016, there was increase in post-transplant survival in the U.S. that was not impacted by change in allocation policy. However, there was notable increase in procedure-related stroke, renal failure requiring dialysis and length of hospitalization stay