Author + information
- Received December 17, 2019
- Revision received February 18, 2020
- Accepted March 6, 2020
- Published online June 29, 2020.
- Oliver K. Jawitz, MDa,b,∗ (, )@ojawitzMD,
- Marat Fudim, MD, MHSb,c,
- Vignesh Raman, MDa,
- Benjamin S. Bryner, MDa,
- Adam D. DeVore, MD, MHSb,c,
- Robert J. Mentz, MDb,c,
- Carmelo Milano, MDa,
- Chetan B. Patel, MDc,
- Jacob N. Schroder, MDa and
- Joseph G. Rogers, MDb,c
- aDivision of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
- bDuke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- cDivision of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Oliver K. Jawitz, Department of Surgery, Duke University School of Medicine, Duke Clinical Research Institute, Box 3850, 200 Morris Street, Durham, North Carolina 27701.
Background An early report of recipient heart transplantation outcomes under the new U.S. heart allocation system introduced in late 2018 found a lower post-transplant survival rate compared with that of the prior system.
Objectives The aim of this study was to examine recipient survival under the new system by using an updated dataset.
Methods The 2015 to 2019 United Network for Organ Sharing registry was queried for adult heart transplant recipients, stratified according to whether the subjects were listed and underwent transplant before or after October 18, 2018, when the new allocation system was implemented. The association between allocation system and recipient mortality was analyzed by using the Kaplan-Meier method and multivariable Cox proportional hazards regression.
Results A total of 7,119 recipients met inclusion criteria: 6,004 (84%) and 1,115 (16%) listed and undergoing transplant in the old and new allocation systems, respectively. This registry update included 576 new-system recipients, more than double the amount previously analyzed. Recipients from the new system were more likely to be bridged to transplant with temporary mechanical circulatory support devices instead of durable left ventricular assist devices and had longer graft ischemic times. After adjustment, the new system was not associated with poorer survival on Kaplan-Meier survival analysis (log-rank test; p = 0.075) or multivariable Cox proportional hazards modeling (adjusted hazard ratio: 1.18; 95% confidence interval: 0.90 to 1.55).
Conclusions The short-term survival of recipients listed and receiving a transplant under the old and new allocation systems seems to be comparable. The modification to the allocation system has resulted in several changes to the clinical profiles of patients undergoing transplants that must be closely monitored in the coming years.
Funding for this study was provided by National Institutes of Health T-32 grants 5T32HL069749 (Dr. Jawitz) and 5T32CA093245 (Dr. Raman). This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. Dr. DeVore has received research funding from AstraZeneca, Amgen, the American Heart Association, Bayer, Luitpold Pharmaceuticals, Medtronic, the National Heart, Lung, and Blood Institute, the Patient-Centered Outcomes Research Institute, and Novartis; consulting services from Amgen, AstraZeneca, Bayer, InnaMed, LivaNova, Mardil Medical, Novartis, Procyrion, scPharmaceuticals, and Zoll; and personal fees from Abbott. Dr. Mentz has received research funding or honoraria from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, Merck, Sanofi, Abbott, Medtronic, and American Regent. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. John Teerlink, MD, served as Guest Editor for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Heart Failure author instructions page.
- Received December 17, 2019.
- Revision received February 18, 2020.
- Accepted March 6, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.