Heart failure & cardiomyopathies
Mid-Term Reassessment of Waitlist and Posttransplant Outcomes Under the 2018 Heart Allocation System: Improved All-Cause Survival
Authors' conclusion
Despite the changes in donor and recipient profiles following the 2018 allocation system change, this mid-term reassessment demonstrates its success in significantly improving waitlist survival, while maintaining comparable posttransplant survival.
Study context
- Population
- Adult waitlisted and transplanted patients undergoing isolated heart transplantation, UNOS registry30,620 waitlisted
- Exposure
- Postpolicy vs prepolicy
- Outcome
- Waitlist outcomes (transplantation, delisting due to death/clinical deterioration, all-cause survival from initial waitlisting) and posttransplant survival
- Follow-up
- 1 year (waitlist); 4 years (posttransplant)
Methodological detailsregistry-based (UNOS), seasonally matched, propensity-score matched, multivariable Cox regression
- Registry-based (UNOS)
- Seasonally matched
- Propensity-score matched
- Multivariable Cox regression
Main finding
As reported in the abstract
Waitlist outcomes · 1 year
Postpolicy vs PrepolicySubhazard ratio (95% CI)P value
Transplantation
2.06(2.00–2.12)
P < 0.001Delisting
0.58(0.53–0.63)
P < 0.001Observational data: associations, not effects.
Further findings
4-year post-transplant survival (posttransplant analysis)
- Similar between the groups (83.3% vs 82.8%)
- P = 0.593
- Comparable 4-year post-transplant survival persisted in the propensity score-matched comparison and multivariable Cox regression
- 13 712 recipients analysed; 4597 (33.5%) transplanted after the policy change
Original publication
Mid-Term Reassessment of Waitlist and Posttransplant Outcomes Under the 2018 Heart Allocation System: Improved All-Cause Survival. Circ Heart Fail. Published 2 July 2025. doi:10.
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