Improved Access to Heart Re-Transplantation with the New Heart Transplant Allocation System

Purpose To evaluate the effect of the new heart transplant allocation system on patients listed for re-transplantation. Methods Adult patients, who were listed for heart re-transplant between Jan 1, 2017 and September 30, 2019, enrolled in the UNOS database were included in this study. Patients were classified in the old or new system if they were listed or re-transplanted before or after October 18, 2018, respectively. Results A total of 214 patients were listed for re-transplant in the study period. Of these, 127 and 87 patients were classified in the old and new systems, respectively. Patients listed in the new system had a higher frequency of transplantation within 1 year of listing (HR: 1.63 (1.23-2.17), p=0.001) (Figure 1A). Patient listed for re-transplant in the new system had a higher frequency of ECMO (16.1% vs. 6.8%, p=0.037) and IABP (20.7% vs. 4.7%, p=0.001) support. A total of 72 and 93 patients were re-transplanted in the old and new systems, respectively. Clinical characteristics did not differ between re-transplanted patients in old vs. new systems. The 1-year post-transplant survival was 91.5% and 86.4% for the old and new systems, respectively (Figure 1B, p=0.35). Conclusion With the implementation of the new HT allocation system, Patients listed for re-transplantation have an increased access to a second heart transplant with similar 1-year post-re-transplant survival.