JHLT open · 2026
Changes in disparities in access and outcomes in heart transplantation among adults with congenital heart disease following the 2018 OPTN allocation policy.
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McCormick Amanda D, Cousino Melissa K, Joynt Michael R, Bucholz Emily M, Sood Vikram, Duimstra Ashley, Yu Sunkyung, Schumacher Kurt R
Аннотация
BACKGROUND: Disparities in heart transplant (HT) outcomes for patients with social drivers of health (SDOH) and adult congenital heart disease (ACHD) are undefined.
METHODS: The Organ Procurement and Transplant Network (OPTN) database was queried for patients ≥18 years of age with a CHD diagnosis listed for HT from 2013 to 2023. Sociodemographic variables and SDOH including a neighborhood socioeconomic status (SES) score and distance to listing center were noted. Outcomes included waitlist time, waitlist mortality, and 1-year post-HT mortality. Patients were divided based on listing before or after the 2018 allocation change. A stratified analysis by era was performed for each outcome using a competing risk model for waitlist mortality and delisting, and logistic regression for 1-year post-HT mortality.
RESULTS: After 2018 (n = 846/1,482, 57.1%), more non-white or Hispanic patients were listed than before 2018 (21.4% vs. 27.4%, p = 0.01). Median waitlist time (6.1 months vs. 3.4 months, p < 0.0001) and waitlist mortality (9.9% vs. 2.1%, p < 0.0001) improved after 2018. Before 2018, lower neighborhood SES was associated with increased waitlist mortality and delisting, which was no longer observed after 2018. A trend towards increased mortality risk was noted after 2018 for patients living >200 miles from their listing center (p = 0.052).
CONCLUSION: Disparities in HT outcomes for ACHD patients with SDOH have improved following the 2018 OPTN allocation change. Distance from transplant care may be a risk factor for early post-HT mortality.
METHODS: The Organ Procurement and Transplant Network (OPTN) database was queried for patients ≥18 years of age with a CHD diagnosis listed for HT from 2013 to 2023. Sociodemographic variables and SDOH including a neighborhood socioeconomic status (SES) score and distance to listing center were noted. Outcomes included waitlist time, waitlist mortality, and 1-year post-HT mortality. Patients were divided based on listing before or after the 2018 allocation change. A stratified analysis by era was performed for each outcome using a competing risk model for waitlist mortality and delisting, and logistic regression for 1-year post-HT mortality.
RESULTS: After 2018 (n = 846/1,482, 57.1%), more non-white or Hispanic patients were listed than before 2018 (21.4% vs. 27.4%, p = 0.01). Median waitlist time (6.1 months vs. 3.4 months, p < 0.0001) and waitlist mortality (9.9% vs. 2.1%, p < 0.0001) improved after 2018. Before 2018, lower neighborhood SES was associated with increased waitlist mortality and delisting, which was no longer observed after 2018. A trend towards increased mortality risk was noted after 2018 for patients living >200 miles from their listing center (p = 0.052).
CONCLUSION: Disparities in HT outcomes for ACHD patients with SDOH have improved following the 2018 OPTN allocation change. Distance from transplant care may be a risk factor for early post-HT mortality.