Fouad Chouairi1, Clancy W Mullan1,2, Sounok Sen1,3, Makoto Mori1,2, Michael Fuery1,3, Robert W Elder4,5, Joshua Lesse3, Kelsey Norton3, Katherine A Clark1,3, P Elliott Miller1,3, David Mulligan1,5, Richard Formica1,6, Joseph G Rogers7, Daniel Jacoby1,3, Christopher Maulion1,3, Muhammad Anwer1,2, Arnar Geirsson1,2, Nihar R Desai1,3, Tariq Ahmad1,3. 1. Yale School of Medicine, New Haven, Connecticut, United States of America. 2. Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, United States of America. 3. Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America. 4. Section of Pediatric Cardiology, Yale School of Medicine, New Haven, Connecticut, United States of America. 5. Division of Transplantation, Yale School of Medicine, New Haven, Connecticut, United States of America. 6. Section of Nephrology, Yale School of Medicine, New Haven, Connecticut, United States of America. 7. Division of Cardiology, Duke University Medical Center, Durham, North Carolina, United States of America.
Abstract
BACKGROUND: Patients with restrictive or hypertrophic cardiomyopathy (RCM/HCM) and congenital heart disease (CHD) do not derive clinical benefit from inotropes and mechanical circulatory support. Concerns were expressed that the new heart allocation system implemented in October 2018 would disadvantage these patients. This paper aimed to examine the impact of the new adult heart allocation system on transplantation and outcomes among patients with RCM/HCM/CHD. METHODS: We identified adult patients with RCM/HCM/CHD in the United Network for Organ Sharing (UNOS) database who were listed for or received a cardiac transplant from April 2017-June 2020. The cohort was separated into those listed before and after allocation system changes. Demographics and recipient characteristics, donor characteristics, waitlist survival, and post-transplantation outcomes were analyzed. RESULTS: The number of patients listed for RCM/HCM/CHD increased after the allocation system change from 429 to 517. Prior to the change, the majority RCM/HCM/CHD patients were Status 1A at time of transplantation; afterwards, most were Status 2. Wait times decreased significantly for all: RCM (41 days vs 27 days; P<0.05), HCM (55 days vs 38 days; P<0.05), CHD (81 days vs 49 days; P<0.05). Distance traveled increased for all: RCM (76 mi. vs 261 mi, P<0.001), HCM (88 mi. vs 231 mi. P<0.001), CHD (114 mi vs 199 mi, P<0.05). Rates of transplantation were higher for RCM and CHD (P<0.01), whereas post-transplant survival remained unchanged. CONCLUSIONS: The new allocation system has had a positive impact on time to transplantation of patients with RCM, HCM, and CHD without negatively influencing survival.
BACKGROUND:Patients with restrictive or hypertrophic cardiomyopathy (RCM/HCM) and congenital heart disease (CHD) do not derive clinical benefit from inotropes and mechanical circulatory support. Concerns were expressed that the new heart allocation system implemented in October 2018 would disadvantage these patients. This paper aimed to examine the impact of the new adult heart allocation system on transplantation and outcomes among patients with RCM/HCM/CHD. METHODS: We identified adult patients with RCM/HCM/CHD in the United Network for Organ Sharing (UNOS) database who were listed for or received a cardiac transplant from April 2017-June 2020. The cohort was separated into those listed before and after allocation system changes. Demographics and recipient characteristics, donor characteristics, waitlist survival, and post-transplantation outcomes were analyzed. RESULTS: The number of patients listed for RCM/HCM/CHD increased after the allocation system change from 429 to 517. Prior to the change, the majority RCM/HCM/CHD patients were Status 1A at time of transplantation; afterwards, most were Status 2. Wait times decreased significantly for all: RCM (41 days vs 27 days; P<0.05), HCM (55 days vs 38 days; P<0.05), CHD (81 days vs 49 days; P<0.05). Distance traveled increased for all: RCM (76 mi. vs 261 mi, P<0.001), HCM (88 mi. vs 231 mi. P<0.001), CHD (114 mi vs 199 mi, P<0.05). Rates of transplantation were higher for RCM and CHD (P<0.01), whereas post-transplant survival remained unchanged. CONCLUSIONS: The new allocation system has had a positive impact on time to transplantation of patients with RCM, HCM, and CHD without negatively influencing survival.