ArticleEuropean journal of medical research2025
Impact of 2018 allocation system change on heart transplantation outcomes in china: a retrospective analysis.
Article in European journal of medical research, 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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Abstract
backgroundIn 2018, China implemented a nationally standardized urgency-based heart allocation system, replacing the previous region-based prioritization approach. However, its impact on waitlist dynamics and post-transplant outcomes remains unclear.
methodsWe retrospectively analyzed heart transplant recipients treated at Fuwai Hospital between 2015 and 2022. The data were obtained from the China Heart Transplant Registry (CHTR). A total of 731 consecutive recipients were stratified into prereform (Era 1) and post-reform (Era 2) cohorts. Era 2 recipients were further classified as urgent or nonurgent. Survival was analyzed using Kaplan-Meier curves and log-rank tests. Multivariable Cox proportional hazards regression identified risk factors for 1-year mortality.
resultsAfter implementation, urgent status transplants increased from 25.7% (2019) to 36.5% (2022), while the waitlist-to-transplant ratio declined from 1.41 to 1.10. Despite COVID-19-related disruptions that peaked waitlist mortality at 15.2% in 2021, urgent recipients had significantly shorter waiting times than nonurgent patients (15 vs. 89 days, P < 0.001). Notably, 1-year survival was similar between eras (92.15% vs. 94.57%, P = 0.181) and urgency groups (93.1% vs. 95.2%, P = 0.324), despite urgent recipients presenting with greater preoperative acuity (71.6% vs. 11.1% IABP dependence), more postoperative complications (74.1% vs. 21.8% IABP support), and longer ICU stays (6 vs. 6 days, P = 0.040). Multivariate analysis identified preoperative dialysis (aHR = 5.67, P = 0.001), elevated bilirubin (aHR = 1.01, P = 0.007), and prolonged cardiopulmonary bypass time (aHR = 1.01/hour, P < 0.001) as predictors of mortality.
conclusionsOur findings provide preliminary evidence that China's urgency-based allocation system prioritizes critically ill recipients while maintaining comparable 1-year survival. These findings provide initial validation of the policy's clinical effectiveness in balancing equity and survival benefits. However, larger and more comprehensive datasets are needed for further confirmation.
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