ArticleJournal of the American Heart Association2025
Clinical Outcomes for Heart-Alone and Multiorgan Transplant Under the New Heart Allocation Policy Era.
Article in Journal of the American Heart Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundIn October 2018, a new heart transplant allocation policy was implemented in the United States to address inequalities. Under the new policy, some patient outcomes for patients with heart transplant have improved; however, outcomes of multiorgan transplants combined with heart remain unclear.
methodsWe examined the waitlist mortality, time to transplant, and posttransplant survival for all patients listed between 2013 and 2022 for multiorgan transplants with heart (n=3798) and compared the old policy era to the new policy era using cumulative incident curves and multivariable Cox regression models. Cumulative incidence curves also compared multiorgan transplants to patients listed for heart alone (n=31 840) under the new policy era.
resultsPatients awaiting multiorgan transplants had higher use of intra-aortic balloon pumps (4.7% versus 11%) and extracorporeal membrane oxygenation support (2.4% versus 4.9%) in the new policy era. Under the new policy, despite receiving transplants sooner (n=2200 transplants, hazard ratio [HR], 1.74 [95% CI, 1.59-1.91]), patients who received multiorgan transplants had no change in waitlist mortality (n=340 deaths, HR, 1.06 [95% CI, 0.84-1.34]) compared with the old policy era. The rate of death post-multiorgan transplant was significantly higher in incidence curves under the new policy compared with the old policy era (log-rank
conclusionsUnder the new policy, waitlist deaths have decreased for patients awaiting heart alone, but not for those awaiting multiorgan transplants. Post-transplant survival remains lower for patients who underwent multiorgan transplant (compared with heart-alone transplant), with no change under the new policy.
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