Outcomes of Heart Transplantation in Adults with Congenital Heart Disease Since UNOS Allocation System Change: UNOS Registry Analysis
Department of Cardiology, Keck Medical Center of University of Southern California, Los Angeles, CA
Meeting: 2020 American Transplant Congress
Abstract number: 297
Keywords: Heart transplant patients, Heart/lung transplantation, Outcome
Session Information
Session Name: Heart Transplantation: Allocation, Allocation, Allocation
Session Type: Oral Abstract Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 4:15pm-4:27pm
Location: Virtual
*Purpose: We sought to examine the waiting list and post-HT outcomes in patients with congenital heart disease (CHD) within UNOS registry since the implementation of the new allocation system and compare them to outcomes prior to this change.
*Methods: Patients with CHD who had undergone heart transplantation 6 months prior to the change in UNOS allocation system (N=144) and patients with CHD who had undergone heart transplantation in the 6 months since the implementation of the new system (N=61) were identified. Variables including age, sex, diabetes status, ethnicity, ischemic time, dialysis, life support measures, days on waiting list, and HLA-mismatch were used for multivariate Cox regression analysis comparing outcomes 6 months before and after UNOS change in allocation system.
*Results: 144 CHD patients post-HT 6 months prior to UNOS system change and 61 CHD post-HT 6 months since UNOS system change were identified. During this study period, 23 patients died (14 pre-UNOS change, 9 post-UNOS change). Waitlisting time prior to HT averaged 67 days in the pre-UNOS change group vs. 35 days in the post-UNOS change group (p < 0.001). In both groups, CHD patients were as likely to require life support with IABP (4.2% vs 8.2%), VAD (16.7% vs 8.2%) and ventilator support (12.5% vs 11.5%). No significant differences were observed in hemodynamic changes between groups. Unadjusted HR for for all-cause mortality post-HT was 3.31 (CI 1.27-8.57, p < 0.014). After adjustment, HR was 5.56 (CI 1.56-19.87, p < 0.008). Survival curve is shown (Figure). Both groups had similar recipient age (p=0.12) and those on dialysis (p=0.26). The pre-UNOS change group had more patients with diabetes (p=0.013).
*Conclusions: CHD patients have demonstrated decreased waiting time in the new UNOS allocation system with concomitant increase in mortality in this short term analysis. Further investigation is warranted to better understand the long-term consequences of the new UNOS allocation system for CHD patients.
To cite this abstract in AMA style:
Genyk P, Yang K, Nattiv J, Liu G, Banankah P, Kingsford P, Li J, Nuno S, Pandya K, Vaidya A, DePasquale E. Outcomes of Heart Transplantation in Adults with Congenital Heart Disease Since UNOS Allocation System Change: UNOS Registry Analysis [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-heart-transplantation-in-adults-with-congenital-heart-disease-since-unos-allocation-system-change-unos-registry-analysis/. Accessed May 13, 2025.« Back to 2020 American Transplant Congress