Changes in waitlist and posttransplant outcomes in patients with adult congenital heart disease after the new heart transplant allocation system

Objective: In 2018, the United Network for Organ Sharing (UNOS) introduced new criteria for heart allocation. This study sought to assess the impact of this change on waitlist and posttransplant outcomes in adult congenital heart disease (ACHD) recipients. Methods: Between January 2010 and March 2020, we extracted first heart transplant ACHD patients listed from the UNOS database. We compared waitlist and post-transplant outcomes before and after the policy change. Results: A total of 1206 patients were listed, 951 under the old policy and 255 under the new policy. Prior to transplant, recipients under the new policy era were more likely to be treated with extracorporeal membrane oxygenation (P =.018), and have intra-aortic balloon pumps (P <.001), and less likely to have left ventricular assist devices (P =.027).Compared to patients waitlisted in the pre-policy change era, those waitlisted in the post policy change era were more likely to receive transplants (P =.001) with no significant difference in waiting list mortality (P =.267) or delisting (P =.915). There was no difference in 1-year survival post-transplant between the groups (P =.791). Conclusion: The new policy altered the heart transplant cohort in the ACHD group, allowing them to receive transplants earlier with no changes in early outcomes after heart transplantation.