The following is a summary of the “Allocation changes in heart transplantation: What has really changed?,” published in the February 2023 issue of Thoracic and cardiovascular surgery by Ganapathi et al.

Status classifications and geographic distribution of donated hearts were updated in 2018. They compared the times before and after the change on a national scale. Using the Scientific Registry of Transplant Recipients database, they found all adult primary, isolated heart transplants performed between October 18, 2017, and October 17, 2019. October 18, 2017 – October 17, 2018 (pre) and October 18, 2018 – October 17, 2019 (post) were the two time periods studied (post). Groups were compared, and a multivariate logistic regression model was developed to determine risk factors for temporary mechanical circulatory support in the donor before transplant. The primary focus was on volume analysis at the regional, state, and central levels.

There were 5,381 separate heart transplants recorded during that time. Temporary mechanical circulatory support increased from 11.1% to 36.2%, and waitlist days decreased from 93 to 41 on unadjusted analysis. Both the amount of time spent in an ischemic state and the total distance traveled increased significantly from before (83 nautical miles) to after (225 nautical miles; P<.01). Postallocation time was independently related to short-term MCS in multivariate analysis (odds ratio, 4.463; 95% CI, 3.844-5.183; P<.001). There was no discernible change in transplant volumes at the regional, state, or center level following the allocation adjustment.

There have been shifts in temporary mechanical circulatory support and the distance and ischemic time associated with transplant since the planned change to the allocation system. Still, there have been no notable shifts in volume. In the coming years, it will be important to monitor the new allocation system’s results and output closely.

Source: sciencedirect.com/science/article/abs/pii/S0022522321005109