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1. Impact of the new heart allocation policy on patients with restrictive, hypertrophic, or congenital cardiomyopathies.

Author

Fouad Chouairi, Clancy W Mullan, Sounok Sen, Makoto Mori, Michael Fuery, Robert W Elder, Joshua Lesse, Kelsey Norton, Katherine A Clark, P Elliott Miller, David Mulligan, Richard Formica, Joseph G Rogers, Daniel Jacoby, Christopher Maulion, Muhammad Anwer, Arnar Geirsson, Nihar R Desai, and Tariq Ahmad

Subjects
Medicine, Science
Abstract

BackgroundPatients 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.MethodsWe 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.ResultsThe 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; PConclusionsThe new allocation system has had a positive impact on time to transplantation of patients with RCM, HCM, and CHD without negatively influencing survival.

Published
2021
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2. Impact of the new heart allocation policy on patients with restrictive, hypertrophic, or congenital cardiomyopathies

Author

Daniel Jacoby, David C. Mulligan, Michael Fuery, Fouad Chouairi, Nihar R. Desai, Kelsey Norton, Clancy W. Mullan, Sounok Sen, Katherine A.A. Clark, Joshua Lesse, Tariq Ahmad, Richard N. Formica, Arnar Geirsson, P. Elliott Miller, Christopher Maulion, Muhammad Anwer, Robert W. Elder, Joseph G. Rogers, and Makoto Mori

Subjects
Male, Inotrope, Heart disease, Cardiovascular Procedures, Economics, Epidemiology, Social Sciences, Cardiovascular Medicine, Vascular Medicine, Medical Conditions, Medicine and Health Sciences, Morphogenesis, Coronary Heart Disease, Medicine, Registries, Cardiomyopathy, Restrictive, Multidisciplinary, Commerce, Hypertrophic cardiomyopathy, Heart, Middle Aged, Cardiac Transplantation, Congenital Heart Defects, Policy, Cardiovascular Diseases, Cohort, Circulatory system, Cardiology, Female, Anatomy, Cardiomyopathies, Research Article, Adult, Heart Defects, Congenital, Procurement, medicine.medical_specialty, Tissue and Organ Procurement, System change, Science, Surgical and Invasive Medical Procedures, Internal medicine, Congenital Disorders, Humans, Birth Defects, cardiovascular diseases, Transplantation, Adult patients, business.industry, Biology and Life Sciences, Organ Transplantation, Cardiomyopathy, Hypertrophic, medicine.disease, United States, Medical Risk Factors, Cardiovascular Anatomy, Heart Transplantation, business, Developmental Biology
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 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.

Published
2021

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