Background While the revised UNOS HTx donor allocation system aimed to minimize waitlist mortality by prioritizing more critically ill transplant candidates, there is concern for increased post‐transplant morbidity and mortality. We examined the impact of the revised allocation system on waitlist and post‐transplant outcomes at a high‐volume transplant center. Methods One hundred and sixty nine adult patients underwent first‐time single‐organ HTx one year before (Era 1:79 patients) and after (Era 2:90 patients) implementation of the new allocation system (10/18/2018). Clinical characteristics, waitlist outcomes, and post‐transplant morbidity and mortality were compared. Results Era 2 patients were twice as likely to be transplanted on temporary mechanical circulatory support (43% vs. 19%, p < .0001). While Era 2 waitlist time was shorter (10 vs. 43 days, p < .001), exception status requests (21.1% vs. 17.9%) and waitlist mortality (3.3% vs. 2.2%) were similar. There was no difference in primary graft dysfunction, intensive care unit or hospital length of stay, readmissions, rejection, allograft vasculopathy, or 1‐year survival (91.1% vs. 93.7%). Conclusions In a high‐volume center, the revised HTx allocation system shortened waitlist time with no significant change in waitlist mortality or observed impact on post‐transplant outcomes. With careful patient selection, the revised allocation system may optimize waitlist and post‐transplant outcomes.

As the SARS‐CoV‐2–pandemic continues to unfold, the number of heart transplants completed in the United States has been declining steadily. The current case series examines the immediate short‐term outcomes of seven heart transplant recipients transplanted during the SARS‐CoV‐2 pandemic. We hope to illustrate that with proper preparation, planning, and testing, heart transplantation can be continued during a pandemic. We assessed 7 patients transplanted from March 4, 2020, to April 15, 2020. The following endpoints were noted: in‐hospital survival, in‐hospital freedom from rejection, in‐hospital nonfatal major cardiac adverse events (NF‐MACE), severe primary graft dysfunction, hospital length of stay, and ICU length of stay. There were no expirations throughout the hospital admission. In addition, there were no patients with NF‐MACE or treated rejection, and 1 patient developed severe primary graft dysfunction. Average length of stay was 17.2 days with a standard deviation of 5.9 days. ICU length of stay was 7.7 days with a standard deviation of 2.3 days. Despite the decreasing trend in completed heart transplants due to SARS‐CoV‐2, heart transplantation appears to be feasible in the immediate short term. Further follow‐up is needed, however, to assess the impact of SARS‐CoV‐2 on post–heart transplant outcomes months after transplantation.

Donor‐specific antibodies (DSAs) in patients prior to heart transplantation are associated with increased risk of rejection and can lead to longer waitlist times, but it is not known whether patients with low/moderate‐level DSA at transplant have acceptable post‐transplant outcomes. We performed a single‐center, retrospective review to examine outcomes associated with crossing pre‐existing low/moderate‐level DSA. We assessed 864 patients awaiting heart transplantation between 2010 and 2018, identified 67 patients with low/moderate‐level DSA and compared them to patients who were sensitized without DSA at the time of heart transplantation, as well as a control group of non‐sensitized patients. Outcomes included 3‐year survival, freedom from cardiac allograft vasculopathy (CAV), freedom from non‐fatal major adverse cardiac events (NF‐MACE), and 1‐year freedom from rejection. In the first‐year post‐transplant, there was decreased freedom from antibody‐mediated rejection (AMR) in the patients with pre‐existing DSA compared with patients sensitized without DSA and non‐sensitized patients. However, the DSA group experienced similar 3‐year post‐transplant survival, freedom from CAV, and freedom from NF‐MACE compared with the other study groups. Our findings suggest that crossing low/moderate‐level DSA does not lead to worse outcomes in heart transplantation and may offer a viable way to increase a sensitized patient's chance to obtain a suitable donor.

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