ArticleJHLT open2026
Impact of the 2018 Allocation Criteria Change on Outcomes Following Cardiac Retransplantation Within 30 Days: Analysis of the United Network for Organ Sharing Database.
Article in JHLT open, 2026. 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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7 authors.
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Abstract
Introduction: Early retransplantation following initial orthotopic heart transplantation (OHT) is a rare occurrence, with early evidence suggesting unfavorable clinical outcomes. In October 2018, the United Network for Organ Sharing (UNOS) implemented the current 6-tier heart allocation system, prioritizing critically ill patients on temporary mechanical support. The impact of this policy change on early retransplantation remains unclear. Methods: We performed a retrospective cohort study using the UNOS database to identify adult patients who underwent cardiac retransplantation within 30 days of their initial OHT between 2014 and 2023. Patients were stratified by the allocation era into two 5-year periods: prior (pre-October 2018) and current (post-October 2018) era. Clinical variables were compared at both the initial and retransplant timepoints. The primary outcome was 1-year survival following retransplantation. Results: Fifty-nine patients met the inclusion criteria, 17 (28.8%) retransplanted in the prior era and 42 (71.2%) in the current era. There were significantly more early retransplanted patients in the current era (42 (0.27%) vs 17 (0.14%), Conclusions: Early cardiac retransplantation is performed in patients with very high acuity and is associated with poor outcomes. Since the 2018 allocation policy change, early retransplantation has become increasingly common, but the outcomes remain very poor with approximately 50% of them not surviving to the first year. These findings highlight important ethical considerations regarding organ allocation and candidate selection when considering early retransplantation.
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