Changing Landscape of Heart Transplantation in the US after Implementation of the New Allocation System: A UNOS Data Registry Analysis.

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]