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The modified US heart allocation system improves transplant rates and decreases status upgrade utilization for

Cody C Fowler1, Mark R Helmers1, Benjamin Smood1

  • 1Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|August 1, 2021
PubMed

Insights

The updated US heart transplant policy improved hypertrophic cardiomyopathy (HCM) patient outcomes by increasing transplant rates and reducing wait times. Waitlist mortality for HCM patients remained stable post-policy change.

Area of Science:

  • Cardiology
  • Transplant Surgery
  • Public Health Policy

Background:

  • Hypertrophic cardiomyopathy (HCM) patients faced high waitlist mortality and functional decline under the prior US heart allocation system.
  • Prior policies often necessitated status exemptions for HCM patients to receive heart transplants.
  • The 2018 policy restructuring aimed to optimize transplant waitlist outcomes.

Purpose of the Study:

  • To evaluate the impact of the revised US heart allocation policy on waitlist mortality and transplant rates in hypertrophic cardiomyopathy patients.
  • To compare outcomes for HCM patients listed before and after the October 18, 2018 policy change.

Main Methods:

  • Retrospective analysis of the United Network for Organ Sharing Transplant Database.
  • Inclusion of adult, primary, single-organ heart transplant recipients with HCM listed between October 2013 and September 2020.
  • Division of patients into two eras based on the allocation policy change: Era 1 (pre-policy) and Era 2 (post-policy).

Main Results:

  • Transplant rates significantly improved in Era 2 (post-policy) compared to Era 1 (pre-policy).
  • Waitlist time decreased substantially for transplanted HCM patients in Era 2 (63.9 days) versus Era 1 (97.1 days).
  • Status upgrade utilization decreased significantly in Era 2, while waitlist mortality and one-year post-transplant survival remained unchanged.

Conclusions:

  • The new heart allocation system has successfully increased heart transplant rates and reduced waitlist times for hypertrophic cardiomyopathy patients.
  • The policy change led to a decrease in the need for status upgrades among HCM patients.
  • Waitlist mortality for HCM patients was not significantly affected by the policy revision.
Abstract

Keywords:
HCMUNOSheart transplanthypertrophic cardiomyopathymodified heart allocation policyoutcomes

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