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The objective of this study is to assess the disparities in heart transplantation (HT) waitlist outcomes according to socioeconomic status (SES) in the old and new HT allocation systems in the US. Adult patients registered for HT in the UNOS database from January 2014 to March 2022 were included. Patients were classified in the old or new system according to listing before or after Oct 18, 2018. SES was calculated according to zip code at time of listing and median household income (MHI) via the US Census Bureau. Competing outcomes in the waitlist were calculated, cumulative frequency of HT and death/delisting due to worsening clinical status were compared among SES and across allocation systems. The interpretation of the data are the responsibility of the authors and in no way should be seen as officially interpretation by OPTN. A total of 26,848 patients met inclusion criteria. At listing, patients (combined old and new systems) in the low SES were more frequently younger, female, African American, had higher BMI and diabetes. The cumulative incidence of HT in the old system was 53.5%, 55.7%, and 57.9% for low, middle and high SES groups (65.3%, 67.6%, 70.2% in the new system); both systems showed increased HT frequency in the high SES group compared to mid and low (Fig. 1A). The cumulative incidence of death/delisting in the old system was similar across SES (low 10.7%, middle 10.3%, high 9.8%). In the new system, the low SES group had a higher cumulative incidence of death/delisting (7.4%) compared to middle (6%) and high (5.4%) SES (Fig. 1B). In the new HT allocation system, SES, determined by MHI, is associated with waitlist outcomes. Patients with low SES had a lower cumulative incidence of HT and increased frequency of death/delisting due to worsening clinical status. [ABSTRACT FROM AUTHOR]

A new heart transplant allocation system was implemented in the US on October 18, 2018. We intended to understand its impact on volume, patient characteristics and outcomes. National data was collected from the UNOS standard transplant analysis and research (STAR) file from 2018 through March 31, 2019, and centers data until June 2019 was collected from the UNOS website (https://optn.transplant.hrsa.gov ; retrieved 8/30/2019). Donor and recipient data were analyzed in a univariate analysis to compare the 10 months (1/18-10/18) preceding the allocation change vs. 5 months (11/18-03/19) after allocation change. This study was approved by the local Institutional Review Board. A total of 3407 patients underwent heart transplantation in 2018 and 1525 between 1/2019-06/2019 of which 809 were done between 1/19-3/19. Of 127 centers, six (4.7%) centers went from high to low volume and 8 (6.2%) from low to high volume. There were, however, significant changes in the average number of transplants done per region between 2018 and 2019 with regions 1,5,7, 10 experiencing a significant increase in transplants/per month (Figure 1 A,B,C). There was a significant increase in "migration" of donor with 30±11% of donor out of region for 2018 vs. 48±17 % 2019,p=0.01 with corresponding increased ischemic time (3.43 ±1 hours vs. 3.15± 1 hours). After the new allocation system, fewer patients were transplanted from LVAD 10% vs 19% p=0.01, while more patients were transplanted from ECMO 4.6% vs 1.5% p=0.01. Graft failure rate was similar between 2018 (10 months) 6.7% vs. 2019 (5 months) 7.8% p=0.2. Centers volume has not changed significantly. There is "migration" of donors from in-region to out of region with increased ischemic time. Region 1,5, 7and 10 have seen a significant increase of average per month of transplant. Graft survival from preliminary data is unchanged. [ABSTRACT FROM AUTHOR]