UNOS policy change benefits high-priority patients without harming those at low priority

Abstract

The heart transplantation policy change (PC) has improved outcomes in high-acuity (Old 1A, New 1–3) patients, but the effect on low-priority (Old 1B/2, New 4–6) patients is unknown. We sought to determine if low-priority patient outcomes were compromised by benefits to high-priority patients by evaluating for interaction between PC and priority status (PS). We included adult first-time heart transplant candidates and recipients from the UNOS registry during a 19-month period before and after the PC. We compared clinical characteristics and performed competing risks and survival analyses stratified by PC and PS. There was a dependence of PC and PS on waitlist death/deterioration with an interaction sub-distribution hazard ratio (adjusted sdHR) of 0.59 (0.45–0.78), p-value