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Impact of the United Network for organ sharing 2018 donor heart allocation system on transplant morbidity and mortality
Author(s) -
Stern Lily K.,
Velleca Angela,
Nishihara Keith,
Shen Adriana,
Zaliznyak Michael,
Patel Jignesh,
Hamilton Michele A.,
Ramzy Danny,
Esmailian Fardad,
Kobashigawa Jon A.,
Kittleson Michelle M.
Publication year - 2021
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14181
Subject(s) - medicine , intensive care unit , united network for organ sharing , heart transplantation , intensive care medicine , emergency medicine , transplantation , liver transplantation
Background While the revised UNOS HTx donor allocation system aimed to minimize waitlist mortality by prioritizing more critically ill transplant candidates, there is concern for increased post‐transplant morbidity and mortality. We examined the impact of the revised allocation system on waitlist and post‐transplant outcomes at a high‐volume transplant center. Methods One hundred and sixty nine adult patients underwent first‐time single‐organ HTx one year before (Era 1:79 patients) and after (Era 2:90 patients) implementation of the new allocation system (10/18/2018). Clinical characteristics, waitlist outcomes, and post‐transplant morbidity and mortality were compared. Results Era 2 patients were twice as likely to be transplanted on temporary mechanical circulatory support (43% vs. 19%, p < .0001). While Era 2 waitlist time was shorter (10 vs. 43 days, p < .001), exception status requests (21.1% vs. 17.9%) and waitlist mortality (3.3% vs. 2.2%) were similar. There was no difference in primary graft dysfunction, intensive care unit or hospital length of stay, readmissions, rejection, allograft vasculopathy, or 1‐year survival (91.1% vs. 93.7%). Conclusions In a high‐volume center, the revised HTx allocation system shortened waitlist time with no significant change in waitlist mortality or observed impact on post‐transplant outcomes. With careful patient selection, the revised allocation system may optimize waitlist and post‐transplant outcomes.