Waitlist Outcomes for Heart Transplant Candidates before and after the 2018 UNOS Allocation Policy Change

Purpose The 2018 UNOS heart allocation policy change was intended to prioritize sicker patients while also improving waitlist outcomes. Here, we investigate competing outcomes of patients waitlisted one year before and after this policy change (10/18/2018). Methods Patients on the waitlist for heart transplant were identified through the UNOS registry one year before (PRE, n=3,924) and after (POST, n=3,825) the UNOS policy change. Baseline characteristics were compared using Mann-Whitney U test and Chi-square test as appropriate. Competing outcomes analysis was performed to compare (1) death or deterioration, (2) heart transplant or recovery, or (3) continuation on waitlist at 6 months. . Results At 180 days, patients in the POST group showed decreased waitlist death or deterioration (5.25% vs 6.37%, p=0.035), greater proportion of transplant or recovery (56.6% vs 48.4%, p Conclusion Following the policy change, there was a reduction in death or deterioration on the waitlist and an increase in the proportion of patients undergoing heart transplantation or experiencing myocardial recovery. Additional analysis is needed to better understand factors contributing to these improved outcomes and longer term implications of this policy change.