Abstract 17947: Variation in Practice Patterns and Outcomes Across UNOS Allocation Regions
Background: Efforts are underway to modify the United Network for Organ Sharing (UNOS) regions for cardiac transplantation to ensure more efficient allocation of organs. Little is known about contemporary patterns of care and variation in wait time, use of advanced therapies, clinical profile, and outcomes of patients across UNOS regions.
Methods: Adult patients undergoing first, single organ heart transplant between January 2006 and December 2014 were identified in the UNOS dataset, which includes detailed clinical information, wait times, use of mechanical circulatory support (MCS), status at the time of transplant, and 1-year survival across the 11 UNOS regions. We used ANOVA for continuous variables and chi-square tests for categorical variables. We reconstructed UNOS regions to minimize mismatch between donor availability and recipients.
Results: We analyzed 17,096 patients undergoing heart transplant. There were no differences in age, sex, renal function, cardiac output, PVR, and cause of cardiomyopathy across regions (p=NS for all). However, there was 3-fold variation in median wait time (range 48-166 days) across region. Clinical severity as reflected by patient status at the time of transplantation varied widely with the proportion of patients undergoing transplant with Status 1A ranging from 36% to 79% with Status 1B ranging from 16% to 52% across regions (Figure; p<0.001 for both). The percentage of patients who were hospitalized at the time of transplant varied from 41% to 98% and there was marked variation in the use of MCS and inotropes (p<0.001 for all). One-year survival across regions varied from 88% to 93%. We successfully restructured UNOS regions to reduce donor-recipient availability mismatch.
Conclusion: Despite homogenous patient characteristics undergoing transplant, there are marked differences in patterns of care, wait times and UNOS status. Novel policy initiatives are required to address disparities in allograft allocation.
Author Disclosures: B.J. Vaccaro: None. T. Ahmad: Speakers Bureau; Modest; Novartis. Consultant/Advisory Board; Modest; Relypsa. Research Grant; Significant; St Judes. P. Rao: None. R. Ghosh: None. P. Warier: None. D.L. Jacoby: None. M. Chen: None. L. Bellumkonda: None. J.M. Testani: None. N.R. Desai: None.
- © 2016 by American Heart Association, Inc.