Geographic Variation Exists in Heart Transplantation for Status One and Two Patients After the 2018 Heart Allocation Policy Change.

Background: The heart transplant allocation policy change in 2018 was intended to help ameliorate differences in waiting times for heart transplantation across UNOS regions. We sought to examine the regional variability in waitlist times and post‐transplant outcomes since these changes were implemented. Methods: The adult patients in the United Network for Organ Sharing registry from October 2018 to December 2022 were included. Regional trends in waitlist time, waitlist events, and post‐transplant outcomes were assessed. Differences in regional variability of successful transplantation over years since policy change were described. Results: A total of 8029 patients were included. The cumulative incidence of successful transplant after 30 days was significantly different across regions (p < 0.001). There was no difference in 30‐day post‐transplant mortality across regions. In each year since the policy change, there continues to be a significant difference in the lowest and highest cumulative incidence of successful transplant at 30 days across regions using difference of difference analysis, suggesting regional variation has not improved over time (p = 0.49). Conclusions: Since the allocation policy change, there continues to be significant variation in time to successful transplantation across geographic regions. [ABSTRACT FROM AUTHOR]