Evaluation of the Effect of the New French Allocation System on Waitlist and Post-Transplant Survival

Purpose The goal of the new French allocation system launched on January 2018 was to minimize death on the waiting list and offer the most equitable access to transplant without detrimental effect on post-transplant outcome. This national system is based on a candidate risk score. The aim of this study was to evaluate the effect of the new system on candidates profile and waitlist and post-transplant survival. Methods The study included all new candidates added to the French waiting list between January 2014 and September 2018. The profile and waitlist outcomes of the candidates registered before (2014-2017) and after (January-September 2018) the introduction of the new system were compared. The profile and post-transplant mortality of recipients were also compared according to the date of transplant. The main outcomes were 1-year waitlist and post-transplant survival. Survival curves were estimated using the Kaplan-Meier method. Results The characteristics of the patients changed after implementation of the new system with more patients on VA-ECMO at listing (22% vs 17%; p=0.01) and at transplant. In 2018, the number of new registrations and transplants increased by 14% and decreased by 4%, respectively. One-year waitlist (Figure 1) and post-transplant (Figure 2) survival did not change between the periods. A better donor-recipient age matching and a decrease in local allocation were observed. Conclusion Despite a-significant increase in the proportion of patients on VA-ECMO at listing and at transplant, 1-year waitlist and post-transplant survival did not change since the implementation of the new allocation system.