An updated estimate of post-transplant survival after implementation of the new donor heart allocation policy
Lazenby KA, Narang N, Pelzer KM, Ran G, Parker WF. An updated estimate of posttransplant survival after implementation of the new donor heart allocation policy. Am J Transplant. 2022;22(6):1683-1690. doi:10.1111/ajt.16931
The Organ Procurement and Transplant Network (OPTN) implemented a new heart allocation policy on October 18, 2018. Published estimates of lower post-transplant survival under the new policy in cohorts with limited follow-up may be biased by informative censoring. Using the Scientific Registry of Transplant Recipients, we used the Kaplan-Meier method to estimate 1-year post-transplant survival for pre-policy (November 1, 2016, to October 31, 2017) and post-policy cohorts (November 1, 2018, to October 31, 2019) with follow-up through March 2, 2021. We adjusted for changes in recipient population over time with a multivariable Cox proportional hazards model. To demonstrate the effect of inadequate follow-up on post-policy survival estimates, we repeated the analysis but only included follow-up through October 31, 2019. Transplant programs transplanted 2594 patients in the pre-policy cohort and 2761 patients in the post-policy cohort. With follow-up through March 2, 2021, unadjusted 1-year post-transplant survival was 90.6% (89.5% - 91.8%) in the pre-policy cohort and 90.8% (89.7% - 91.9%) in the post-policy cohort (adjusted HR = 0.93 [0.77-1.12]). Ignoring follow-up after October 31, 2019, the post-policy estimate was biased downward (1-year: 82.2%). When estimated with adequate follow-up, 1-year post-transplant survival under the new heart allocation policy was not significantly different.