The 2018 adult heart allocation policy change benefits low-volume transplant centers.
Clin Transplant
; 35(8): e14389, 2021 08.
Article
in En
| MEDLINE
| ID: mdl-34154036
ABSTRACT
INTRODUCTION:
The effect of the 2018 adult heart allocation policy change at an institution-level remains unclear. The present study assessed the impact of the policy change by transplant center volume.METHODS:
The United Network for Organ Sharing database was queried for all adults undergoing isolated heart transplantation from November 2016 to September 2020. Era 1 was defined as the period before the policy change and Era 2 afterwards. Hospitals were divided into low-(LVC) medium-(MVC) and high-volume (HVC) tertiles based on annual transplant center volume. Competing-risks regressions were used to determine changes in waitlist death/deterioration, while post-transplant mortality was assessed using multivariable Cox proportional-hazards models.RESULTS:
A total of 3531 (47.0%) patients underwent heart transplantation in Era 1 and 3988 (53.0%) in Era 2. At LVC, Era 2 patients were less likely to experience death/deterioration on the waitlist (subhazard ratio .74, 95% CI .63-.88), while MVC and HVC patients experienced similar waitlist death/deterioration across eras. After adjustment, transplantation in Era 2 was associated with worse 1-year mortality at MVC (hazard ratio, HR, 1.42 95% CI 1.02-1.96) and HVC (HR 1.42, 95% CI 1.02-1.98) but not at LVC.CONCLUSION:
Early analysis shows that LVC may be benefitting under the new allocation scheme.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Heart Transplantation
/
Transplants
Type of study:
Prognostic_studies
Limits:
Adult
/
Humans
Language:
En
Journal:
Clin Transplant
Journal subject:
TRANSPLANTE
Year:
2021
Type:
Article
Affiliation country:
United States