Advertisement
The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Outcomes in the 2018 UNOS donor heart allocation system: A perspective on disparate analyses

  • Author Footnotes
    1 These authors have contributed equally to this work.
    Anubodh S. Varshney
    Footnotes
    1 These authors have contributed equally to this work.
    Affiliations
    Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Author Footnotes
    1 These authors have contributed equally to this work.
    Sameer A. Hirji
    Footnotes
    1 These authors have contributed equally to this work.
    Affiliations
    Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Michael M. Givertz
    Correspondence
    Reprint requests: Michael M. Givertz, MD, Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Telephone: 617-525-7052. Fax: 617-264-5265.
    Affiliations
    Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Author Footnotes
    1 These authors have contributed equally to this work.
      The United Network for Organ Sharing (UNOS) implemented a revised donor heart allocation system on October 18, 2018 with principle aims to reduce waitlist mortality, enhance geographic organ sharing, and improve organ distribution equity. Five recently published analyses compared outcomes of heart transplant (HT) recipients transplanted under the revised versus previous system. All demonstrated increased pre-transplant temporary mechanical circulatory support use and graft ischemic times under the revised system. However, despite using data from the same UNOS Registry, three analyses demonstrated increased risk of post-transplant mortality under the revised system, while two others found no significant difference in mortality risk. These studies differed in their analytic cohorts, study periods, follow-up duration, and statistical methodologies. Additionally, some may have introduced survivor bias or violated non-informative censoring. Given these variable findings, longer-term outcome assessment is warranted before the HT community can truly understand the impact of the 2018 UNOS system revision on post-transplant outcomes.

      KEYWORDS

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Heart and Lung Transplantation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. U.S. Department of Health and Human Services. Organ Procurement and Transplantation Network: adult heart allocation. Available at:https://optn.transplant.hrsa.gov/learn/professional-education/adult-heart-allocation/.

        • Cogswell R
        • John R
        • Estep JD
        • et al.
        An early investigation of outcomes with the new 2018 donor heart allocation system in the United States.
        J Heart Lung Transplant. 2020; 39: 1-4
        • Jawitz OK
        • Fudim M
        • Raman V
        • et al.
        Reassessing recipient mortality under the new heart allocation system: an updated UNOS Registry analysis.
        JACC Heart Fail. 2020; 8: 548-556
        • Kilic A
        • Hickey G
        • Mathier MA
        • et al.
        Outcomes of the first 1300 adult heart transplants in the United States after the allocation policy change.
        Circulation. 2020; 141: 1662-1664
      2. Goff RR, Uccellini K, Lindblad K, et al. A change of heart: preliminary results of the US 2018 adult heart allocation revision [e-pub ahead of print]. Am J Transplant doi:10.1111/ajt.16010, accessed May 22, 2020.

        • Trivedi JR
        • Slaughter MS.
        “Unintended” consequences of changes in heart transplant allocation policy: impact on practice patterns.
        ASAIO J. 2020; 66: 125-127
        • Stewart GC
        • Givertz MM
        • Mehra MR
        Pump thrombosis redux.
        J Heart Lung Transplant. 2015; 34: 1511-1514
        • Bland JM
        • Altman DG
        Survival probabilities (the Kaplan-Meier method).
        BMJ. 1998; 317: 1572
        • Parker WF
        • Churpek MM
        • Anderson AS
        Is it too early to investigate survival outcomes of the new US heart allocation system?.
        J Heart Lung Transplant. 2020; 39: 726
        • Hanff TC
        • Harhay MO
        • Kimmel SE
        • Birati EY
        • Acker MA
        Update to an early investigation of outcomes with the new 2018 donor heart allocation system in the United States.
        J Heart Lung Transplant. 2020; 39: 725-726
        • Jasseron C
        • Lebreton G
        • Cantrelle C
        • et al.
        Impact of heart transplantation on survival in patients on venoarterial extracorporeal membrane oxygenation at listing in France.
        Transplantation. 2016; 100: 1979-1987
        • Coutance G
        • Jacob N
        • Demondion P
        • et al.
        Favorable outcomes of a direct heart transplantation strategy in selected patients on extracorporeal membrane oxygenation support.
        Crit Care Med. 2020; 48: 498-506
        • Parker WF
        • Chung K
        • Anderson AS
        • Siegler M
        • Huang ES
        • Churpek MM
        Practice changes at U.S. transplant centers after the new adult heart allocation policy.
        J Am Coll Cardiol. 2020; 75: 2906-2916
        • Varshney AS
        • Berg DD
        • Katz JN
        • et al.
        Use of temporary mechanical circulatory support for management of cardiogenic shock before and after the United Network for Organ Sharing Donor Heart Allocation System changes.
        JAMA Cardiol. 2020; 5: 1-6