Early Trends in Cardiac Allograft Vasculopathy After Implementation of the 2018 Donor Heart Allocation Policy in the United States: Short Title: CAV Trend After Allocation Policy Change.

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Abstract

STUDY OBJECTIVE: To evaluate the impact of the new donor heart allocation system implemented in the United States in October 2018 on development of early cardiac allograft vasculopathy (CAV).DESIGN: Retrospective cohort study.PARTICIPANTS: Adult (= 18 years) heart transplant recipients registered in the United Network for Organ Sharing database between October 18, 2015 - October 17, 2018 (old system) and October 18, 2018 - May 31, 2020 (new system).MAIN OUTCOME MEASURE: Incidence of angiographic CAV at 1 year (accelerated CAV) in the overall transplant population and among the highest acuity subgroup-Status 1A (old) and Status 1 or 2 (new). We included recipient and donor demographic, cardiovascular, and transplant factors in multivariable logistic regression models to identify predictors of accelerated CAV.RESULTS: Of 10,375 transplant recipients, 6,660 (64%) and 3,715 (36%) were listed in the old and new allocation cohorts, respectively. The incidence of accelerated CAV was 521 (8%) in the old period compared with 272 (7%) in the new period (p?=?0.36). Similar incidence rates were observed in the highest acuity subgroup-363 (8%) compared with 143 (7%), respectively (p?=?0.13). In adjusted analyses of the high-acuity cohort, the new allocation system was not associated with a higher likelihood of accelerated CAV (odds ratio?=?0.87, 95% confidence interval: 0.70-1.08, p?=?0.20).CONCLUSIONS: The new donor heart allocation system is not associated with development of accelerated angiographic CAV at 1 year, including among recipients requiring the most urgent transplants.

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