Outcomes Poorer With New U.S. Donor Heart Allocation System
Early observations show lower waitlist mortality but higher posttransplant mortality or retransplantation
WEDNESDAY, Nov. 27, 2019 (HealthDay News) -- Change in the U.S. allocation system for donor hearts has reduced waitlist mortality, but posttransplantation outcomes may have been worsened, according to a research letter published online Nov. 20 in the Journal of Heart and Lung Transplantation.
Rebecca Cogswell, M.D., from the University of Minnesota in Minneapolis, and colleagues compared heart transplant patients listed and transplanted in the three years prior to the United Network for Organ Sharing (UNOS) allocation change (Oct. 18, 2015, to Oct 18, 2018) with those listed and transplanted under the new system (Oct. 19, 2018, to March 31, 2019).
The researchers found that most transplants in the new system occurred in urgency status 1, 2, and 3 (83 percent). In the new and prior systems, the 90-day survival estimates were 87.6 and 94.5 percent, respectively, and 180-day survival estimates were 77.9 and 93.4 percent, respectively. Patients listed and transplanted in the new system experienced a higher hazard rate for death or retransplantation in multivariate models (unadjusted hazard ratio, 2.1; adjusted hazard ratio, 2.1). Survival at 180 days on the waitlist was 95.0 and 96.1 percent in the previous system and new system, respectively. The new system was protective against waitlist mortality in a competing risk analysis (adjusted hazard ratio, 0.43).
"A better understanding of the factors underlying these findings will likely serve to improve the outcomes for our patients undergoing heart transplantation in the United States," the authors write.