Changes in disparities in access and outcomes in heart transplantation among adults with congenital heart disease following the 2018 OPTN allocation policy.

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.