Abstract 16006: Regional Differences in Recipient Waitlist Time and Pre-and Post-Transplant Mortality Following the 2006 UNOS Policy Changes in the Donor Heart Allocation Algorithm
Background: The 2006 UNOS thoracic organ allocation policy change was implemented to allow for greater regional sharing of organs. We examined the impact of UNOS policy changes for regional differences in waitlist time and mortality before and after heart transplantation.
Methods: We analyzed 37,342 patients who were listed for heart transplantation from January 1999 through April 2012. These patients were separated into two eras centered on the July 11, 2006 UNOS policy change (era 1: January 1999-July 12, 2006; era 2: July 12, 2006-April 2012). Pre- and post-transplantation characteristics were compared by UNOS regions.
Results: Waitlist mortality decreased nationally (180 days: 9.9 versus 5.6% after the UNOS policy change, p<0.001) and within each region. Similarly, two-year post-transplant mortality decreased nationally (2 year mortality: 17.2% vs. 12.4%; p<0.001) as well as regionally. Waitlist time for UNOS status 1A & 1B candidates increased nationally 17.8 days on average (p<0.001) with variability between the regions. The greatest increases were in Region 9 (58.6 day increase, p<0.001) and Region 4 (41.1 day increase, p<0.001). While the use of mechanical circulatory support increased nearly six-fold nationally in Era 2, significant differences were present on a regional basis. In Regions 7 & 9, nearly 40% of those transplanted required LVAD bridging while only 20.8% and 18.9% required an LVAD in regions 3 & 4, 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 though overall both waitlist mortality and post-transplant survival are improved.
- © 2013 by American Heart Association, Inc.