Author + information
- Received May 10, 2013
- Revision received November 14, 2013
- Accepted November 28, 2013
- Published online April 1, 2014.
- P. Christian Schulze, MD, PhD∗∗ (, )
- Shuichi Kitada, MD, PhD∗,
- Kevin Clerkin, MD∗,
- Zhezhen Jin, PhD† and
- Donna M. Mancini, MD∗
- ∗Department of Medicine, Division of Cardiology, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
- †Division of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. P. Christian Schulze, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, PH 10-203, New York, New York 10032.
Objectives This study examined the impact of the United Network for Organ Sharing (UNOS) policy changes for regional differences in waitlist time and mortality before and after heart transplantation.
Background The 2006 UNOS thoracic organ allocation policy change was implemented to allow for greater regional sharing of organs for heart transplantation.
Methods We analyzed 36,789 patients who were listed for heart transplantation from January 1999 through April 2012. These patients were separated into 2 eras centered on the July 12, 2006 UNOS policy change. Pre- and post-transplantation characteristics were compared by UNOS regions.
Results Waitlist mortality decreased nationally (up to 180 days: 13.3% vs. 7.9% after the UNOS policy change, p < 0.001) and within each region. Similarly, 2-year post-transplant mortality decreased nationally (2-year mortality: 17.3% vs. 14.6%; p < 0.001) as well as regionally. Waitlist time for UNOS status 1A and 1B candidates increased nationally 17.8 days on average (p < 0.001) with variability between the regions. The greatest increases were in Region 9 (59.2-day increase, p < 0.001) and Region 4 (41.2-day increase, p < 0.001). Although the use of mechanical circulatory support increased nearly 2.3-fold nationally in Era 2, significant differences were present on a regional basis. In Regions 6, 7, and 10, nearly 40% of those transplanted required left ventricular assist device bridging, whereas only 19.6%, 22.3%, and 15.5% required a left ventricular assist device in regions 3, 4, and 5, respectively.
Conclusions The 2006 UNOS policy change has resulted in significant regional heterogeneity with respect to waitlist time and reliance on mechanical circulatory support as a bridge to transplantation, although overall both waitlist mortality and post-transplant survival are improved.
This work was supported by grants from the National Heart, Lung, and Blood Institute (K23 HL095742-01, P30 HL101272-01, UL1 RR 024156, HL073029; New York, New York) and the Herbert and Florence Irving Scholar Award to Dr. Schulze. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Drs. Schulze and Kitada contributed equally to this work.
- Received May 10, 2013.
- Revision received November 14, 2013.
- Accepted November 28, 2013.
- American College of Cardiology Foundation