Update to an early investigation of outcomes with the new 2018 donor heart allocation system in the United States

Recently, Cogswell and colleagues presented an analysis of changes in waitlist and post-transplant survival after modifications to the United States adult donor heart allocation system in October 2018. Based on early data from the United Network for Organ Sharing (UNOS) registry with follow-up through June 6, 2019, the analysis demonstrated a significant increase in the unadjusted hazard of post-transplant death or retransplantation up to 180 days among single-organ recipients (HR: 2.1, 95% CI: 1.5–3.0, p < 0.001). 

Many centers had been concerned about the possibility of this result based on shifts in patient selection for transplant and bridging practices. However, replication of this analysis using more recent UNOS data with follow-up through September 27, 2019, demonstrates a much smaller increase in 180-day mortality that is not statistically significant compared with the prior allocation system. We report these results and suggest possible reasons for this discrepancy that are overcome with longer follow-up.

National Heart,Lung,and Blood Insititute(NHLBI)