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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]