• J. Thorac. Cardiovasc. Surg. · Feb 2024

    Increasing waiting times for Status 2 patients in new UNOS allocation system: impact on waitlist and post-transplant outcomes.

    • Sameer K Singh, Mohamed Hassanein, Yuming Ning, Chunhui Wang, Paul Kurlansky, Kevin Clerkin, Gabriel Sayer, Nir Uriel, and Koji Takeda.
    • Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
    • J. Thorac. Cardiovasc. Surg. 2024 Feb 1; 167 (2): 535543.e3535-543.e3.

    ObjectiveSince the heart transplant allocation policy change in 2018, there has been an increase in temporary mechanical circulatory support for Status 2 patients. We sought to examine the temporal pattern of waitlist and posttransplant outcomes for Status 2 patients.MethodsAdult patients in the United Network for Organ Sharing registry who were listed as Status 2 from January 2019 to June 2022 were included. Temporal trends in waitlist time, waitlist events, and posttransplant outcomes were assessed. Probability of transplant or death after being listed was compared over time. Multivariable regression was performed to identify risk factors for mortality after transplant.ResultsA total of 6310 patients were included. From 2019 to 2022, the number of Status 2 patients listed increased from 4.2 to 5.9 per day. Microaxial ventricular assist devices at Status 2 listing increased over time (P < .001). During the study period, median waitlist time (18 days vs 23 days, P < .001) as well as Status 2 days (8 days vs 12 days, P < .001) increased. Waitlist mortality remained stable (5.5%); however, probability of transplant within 90 days of Status 2 listing progressively declined (P < .001). Finally, longer waitlist duration was independently associated with 30-day posttransplant mortality (odds ratio, 1.01; 95% confidence interval, 1.00-1.01, P = .02).ConclusionsSince the allocation policy change there has been a steady rise in the number of patients listed for Status 2. This has led to increasing waitlist times and lower probability of transplantation for Status 2 patients, which may have negative consequences for posttransplant outcomes.Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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