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Allocation changes in heart transplantation: What has really changed?

Asvin M Ganapathi1, Brent C Lampert2, Nahush A Mokadam1

  • 1Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.

The Journal of Thoracic and Cardiovascular Surgery
|April 20, 2021
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Summary
This summary is machine-generated.

The 2018 heart transplant allocation change increased temporary mechanical circulatory support use and travel distance, but did not alter transplant volumes. Further study is needed to assess long-term outcomes under the new system.

Keywords:
allocationheart transplanttemporary mechanical circulatory support

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Area of Science:

  • Cardiology
  • Transplant Surgery
  • Public Health Policy

Background:

  • The 2018 heart allocation system revision aimed to improve equity and efficiency.
  • Key changes included revised status classifications and expanded geographic distribution for heart transplants.

Purpose of the Study:

  • To evaluate the immediate impact of the 2018 heart allocation system changes on national transplant practices.
  • To analyze shifts in temporary mechanical circulatory support use, waitlist times, travel distance, and ischemic times.

Main Methods:

  • Utilized the Scientific Registry of Transplant Recipients database for adult primary, isolated heart transplants.
  • Compared data from the pre-allocation change period (Oct 2017-Oct 2018) with the post-allocation change period (Oct 2018-Oct 2019).
  • Conducted unadjusted and multivariable logistic regression analyses, including volume analysis at regional, state, and center levels.

Main Results:

  • A significant increase in temporary mechanical circulatory support use (11.1% to 36.2%) and a decrease in waitlist days (93 to 41) were observed post-change.
  • Increased travel distance (83 to 225 nautical miles) and ischemic time (3.0 to 3.4 hours) were also noted.
  • The post-allocation period was independently associated with temporary mechanical circulatory support use (OR, 4.463; P < .001).
  • No significant changes in transplant volumes at regional, state, or center levels were found.

Conclusions:

  • The 2018 heart allocation system changes led to increased use of temporary mechanical circulatory support and longer travel/ischemic times.
  • Transplant volumes remained stable nationally and regionally despite the allocation system modifications.
  • Ongoing monitoring of patient outcomes and transplant volumes under the new allocation system is crucial.