OPTN/SRTR 2024 Annual Data Report: Heart

In 2024, the total number of heart transplants in the United States reached a record of 4,636, an 81.5% increase since 2013. Of these, 4,146 occurred in adults while 490 occurred in pediatric recipients (93.5% and 19.2% increases, respectively, since 2013). This growth has been insufficient to meet the demand, as the number of adult patients awaiting transplant has always far exceeded the number of transplants performed. This is compounded by increasing numbers of new listings, although new adult listings have increased to a lesser extent (by 57.0%) than adult transplants since 2013. Pediatric heart transplants have only increased 19.2% since 2013, with an apparent plateau since 2018. Except for pediatric candidates aged 12-17 years and those who turned 18 while waiting, there has been a decline in heart transplant rates since 2013: in candidates younger than 1 year, a 48.2% decrease (123.6 [in 2024] versus 238.5 [in 2013] transplants per 100 patient-years); in those aged 1-5 years, a 41.4% decrease (54.0 versus 92.1 transplants per 100 patient-years); and in those aged 6-11 years, an 18.2% decrease (71.0 versus 86.8 transplants per 100 patient-years). The prevalence of heart donors after circulatory death increased to 17.9%. Pretransplant mortality in adults declined slightly, to 8.4 deaths per 100 patient-years, and in pediatric candidates reached a 10-year low of 8.2 deaths per 100 patient-years. Most adult heart transplants (54.9%) were performed at adult status 2, while most pediatric heart transplants (88.8%) were performed at status 1A. There were 974 transplants performed in adults with Impella only, 716 with intra-aortic balloon pump only, and 189 with extracorporeal membrane oxygenation only. The 1- and 5-year survival after transplant remained stable (for transplants in 2017-2019): 91.2% and 80.1% in adults and 92.3% and 83.9% in pediatric recipients, respectively. Two-year survival was lowest in recipients listed at adult status 5 (79.3%) and highest in recipients listed at adult status 6 (91.1%).