BACKGROUND: A change in allocation algorithm in July 2006 allowed broader regional sharing of donor hearts in the United States (US). We assessed if the allocation change has been associated with a decline in wait list mortality in the US. METHODS AND RESULTS: We compared baseline characteristics and outcomes in patients ≥18 years old listed for a primary heart transplant in the US before (July 1, 2004-July 11, 2006, Era1) and after (July 12, 2006-June 30, 2009, Era 2) the change in allocation algorithm. Of 11 864 patients in the study, 4503 were listed during Era 1 and 7361 during Era 2. Patients listed during Era 2 were more likely to be listed status 1A, have an implantable cardioverter-defibrillator, and supported on a continuous flow assist device (P<0.001 for distribution. Patients listed in Era 2 were at a 17% lower risk of dying on the wait list or becoming too sick to transplant (adjusted hazard ratio, 0.83, 95% CI 0.75, 0.93). Transplant recipients in Era 2 were more likely to be transplanted as status 1A (37% versus 48%, respectively, P<0.001). Post-transplant in-hospital mortality (6.3% versus 5.4%; adjusted odds ratio, 0.86 for Era 2, 95% CI 0.79, 1.06) and 1-year survival were similar. CONCLUSIONS: The risk of death on the wait list or becoming too sick to transplant has decreased by 17% in the US since the allocation algorithm allowing broader regional sharing was implemented in 2006. The shift in hearts to sicker candidates has not resulted in higher in-hospital or first year post-transplant mortality.
BACKGROUND: A change in allocation algorithm in July 2006 allowed broader regional sharing of donor hearts in the United States (US). We assessed if the allocation change has been associated with a decline in wait list mortality in the US. METHODS AND RESULTS: We compared baseline characteristics and outcomes in patients ≥18 years old listed for a primary heart transplant in the US before (July 1, 2004-July 11, 2006, Era1) and after (July 12, 2006-June 30, 2009, Era 2) the change in allocation algorithm. Of 11 864 patients in the study, 4503 were listed during Era 1 and 7361 during Era 2. Patients listed during Era 2 were more likely to be listed status 1A, have an implantable cardioverter-defibrillator, and supported on a continuous flow assist device (P<0.001 for distribution. Patients listed in Era 2 were at a 17% lower risk of dying on the wait list or becoming too sick to transplant (adjusted hazard ratio, 0.83, 95% CI 0.75, 0.93). Transplant recipients in Era 2 were more likely to be transplanted as status 1A (37% versus 48%, respectively, P<0.001). Post-transplant in-hospital mortality (6.3% versus 5.4%; adjusted odds ratio, 0.86 for Era 2, 95% CI 0.79, 1.06) and 1-year survival were similar. CONCLUSIONS: The risk of death on the wait list or becoming too sick to transplant has decreased by 17% in the US since the allocation algorithm allowing broader regional sharing was implemented in 2006. The shift in hearts to sicker candidates has not resulted in higher in-hospital or first year post-transplant mortality.
Authors: Omar Wever-Pinzon; Stavros G Drakos; Abdallah G Kfoury; Jose N Nativi; Edward M Gilbert; Melanie Everitt; Rami Alharethi; Kim Brunisholz; Feras M Bader; Dean Y Li; Craig H Selzman; Josef Stehlik Journal: Circulation Date: 2012-12-27 Impact factor: 29.690
Authors: Lakshmi Sridharan; Brian Wayda; Lauren K Truby; Farhana Latif; Susan Restaino; Koji Takeda; Hiroo Takayama; Yoshifumi Naka; Paolo C Colombo; Mathew Maurer; Maryjane A Farr; Veli K Topkara Journal: Circ Heart Fail Date: 2018-03 Impact factor: 8.790
Authors: John C Loh; Julie Creaser; Darlene A Rourke; Nancy Livingston; Tamara K Harrison; Elizabeth Vandenbogaart; Jaime Moriguchi; Michele A Hamilton; Chi-Hong Tseng; Gregg C Fonarow; Tamara B Horwich Journal: Circ Heart Fail Date: 2013-03-11 Impact factor: 8.790
Authors: Nir Uriel; Ulrich P Jorde; Sang Woo Pak; Jeff Jiang; Kevin Clerkin; Hiroo Takayama; Yoshifumi Naka; P Christian Schulze; Donna M Mancini Journal: J Heart Lung Transplant Date: 2013-02 Impact factor: 10.247