Waitlist Outcomes in Patients with Dilated Cardiomyopathy before and after UNOS Heart Allocation Policy Change

• Published in: The Journal of heart and lung transplantation Vol. 40; no. 4; p. S248
• Main Authors: Yang, K., Sharma, A., Saffarian, M., Miller, S.R., Vaidya, A.S., Wolfson, A.M., Depasquale, E.C.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2021
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2021.01.709

We sought to analyze six-month waitlist outcomes among patients with dilated cardiomyopathy to see if the UNOS policy allocation change (10/18/2018) affected outcomes. In the UNOS database, we identified 6,294 registered heart transplant candidates from October 18, 2017 to October 17, 2019. There were 3,226 candidates in the 12 months prior to the policy change (PRE), and 3,068 in the 12 months after (POST). Baseline characteristics via Mann Whitney U test and Chi square test were compared with respect to age, gender, race, and baseline hemodynamics. Competing outcomes analysis was performed to compare (1) death or deterioration, (2) heart transplantation or recovery, or (3) continuation on the waitlist at 6 months from the time of listing. At 6 months, the POST allocation policy change group had a trend toward decreased death or deterioration (5.3% vs. 6.3%, p=0.08), decreased percentage of patients remaining on the waitlist (39.5% vs. 46.7%, p < 0.001), and increased heart transplantation or recovery (55.3% vs. 47.0%, p < 0.001). The POST group was slightly younger (56 years old vs. 58 years old, p=0.002), however other baseline characteristics such as gender and hemodynamic measurements were similar between both groups. Since the UNOS policy change, there has been a trend towards increased incidence of transplantation or recovery, and decreased incidence of death or deterioration for waitlisted patients with DCM at 6 months. This analysis suggests that the allocation change has improved waitlist survival outcomes in DCM patients, but more time is warranted to see if this effect persists.