Transplant Survival and Competing Outcomes after UNOS Allocation Policy Change

Purpose UNOS allocation took effect in October of 2018 after much long debate. It is unclear what are the implications of this change on transplant outcomes and mortality and morbidity of the patients on the waitlist. We sought to examine these competing outcomes before and after allocation change. Methods We queried the UNOS registry and identified all patients that were transplanted or on the waiting list within 6 months before and after allocation change. We excluded patients that were Results We identified 976 patients that were transplanted within 6 months before UNOS allocation change in October 2018 and compared it to 545 patients that were transplanted within the 6 months after. We also identified 1948 patients that were waitlisted before and 1674 after allocation change. Post-transplant survival is shown (Figure 1A-C). Waiting list outcomes at 6 months (pre and post change): death 3% vs 3%, transplant 46% vs 46%, deterioration 3% vs 3%, recovery 1% vs 1%, waiting 15% vs 16%. Unadjusted HR for all-cause mortality post heart transplant was 3.22 (CI 1.97-5.27, p Conclusion After the UNOS allocation change in October 2018, there was an increase in transplant mortality. There is no difference in waitlist morbidity and mortality compared to the time immediately after allocation change. Longer study is necessary to assess the impact of allocation change on overall transplant survival.