Increased Utilization with Preserved Survival of Multiorgan Heart Transplantation in the New US Heart Allocation System – a Nationwide Analysis
Presented During:
Monday, May 4, 2026: 9:00AM - 4:00PM
McCormick Place Lakeside Center
Posted Room Name:
Exhibit Hall, Poster Area
Abstract No:
P0136
Submission Type:
Abstract Submission
Authors:
Koray Potel (1), Sean Nguyen (1), Cole Myers (1), Emma Schaffer (2), Stephen Huddleston (3), Tamas Alexy (1), Rebecca Cogswell (1), Rosemary Kelly (1), Andrew Shaffer (2), Ranjit John (2)
Institutions:
(1) University of Minnesota, Minneapolis, MN, (2) University of Minnesota Medical Center, Minneapolis, MN, (3) University of Minnesota Medical School, Saint Paul, MN
Submitting Author:
Koray Potel
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University of Minnesota
University of Minnesota
Co-Author(s):
Sean Nguyen
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University of Minnesota
University of Minnesota
Cole Myeres
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University of Minnesota
University of Minnesota
Emma Schaffer
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University of Minnesota Medical Center
University of Minnesota Medical Center
Stephen Huddleston
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University of Minnesota Medical School
University of Minnesota Medical School
Tamas Alexy
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University of Minnesota
University of Minnesota
Rebecca Cogswell
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University of Minnesota
University of Minnesota
*Rosemary Kelly
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University of Minnesota
University of Minnesota
Andrew Shaffer
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University of Minnesota Medical Center
University of Minnesota Medical Center
*Ranjit John
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University of Minnesota Medical Center
University of Minnesota Medical Center
Presenting Author:
Koray Potel
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University of Minnesota
University of Minnesota
Abstract:
Objective: To study nationwide trends and outcomes of multiorgan heart transplantation (HTx) before and after the 2018 change in the US heart allocation system.
Methods: Organ Procurement and Transplantation Network data was used to identify adult patients who underwent HTx between 01/01/2011 and 06/30/2025 (Single Heart (SH) = 37273, Heart-Kidney (HK) = 2810, Heart-Liver (HLi) = 586, Heart-Lung (HLu) = 483). Baseline characteristics, in-hospital outcomes and one-year survival (adjusted and unadjusted) were compared before and after the allocation system change.
Results: Between 2011 and 2025, 114/152 US HTx centers performed multiorgan HTx. HLi and HLu had higher overall one-year mortality compared to SH (SH: 8.11%; HK: 11.46%, adjusted p=0.1; HLi: 15.36%, p<0.001; HLu: 17.18%, p<0.001). Rates of all types of multiorgan HTx increased in the new allocation era (p<0.01, Figure 1). HK recipients in the new allocation era were more likely to have been on extracorporeal membrane oxygenation (ECMO) support at the time of HTx (1% vs 6.5%, p<0.001) and had shorter waitlist time (87 vs 36 days, p<0.001). While dialysis before discharge (28.6% vs 37.2%, p<0.001) and longer inpatient stay (20 vs 21 days, p=0.005) were more prevalent in the new era, one-year mortality remained unchanged (11.8% vs 11.3%, adjusted HR: 0.92 [0.71-1.18], p=0.5). In the new allocation era, HLi recipients were older (44 vs 49 years, p<0.001), more likely to be on ECMO support (0.6% vs 5.4%, p=0.013), and had fewer waitlist days (109 vs 60, p<0.001). Like HK, HLi showed increased rates of post-HTx dialysis (23% vs 36%, p=0.003) and length of stay (23 vs 28 days, p=0.003), but no significant difference in adjusted one-year mortality (10.9% vs 17.3%, HR: 1.68 [0.95-2.97], p=0.07). HLu recipients in the new allocation era were more frequently on ECMO (16.2% vs 28.8%, p=0.003) and had a shorter waitlist time (72 vs 41 days, p=0.002). In-hospital outcomes and one-year mortality were comparable between the allocation eras (19.8% vs 15.8%, HR 0.77 [0.48-1.22], p=0.268).
Conclusions: The new allocation system achieved an increase in multiorgan HTx in patients with higher clinical acuity and a significant reduction in waitlist time while maintaining survival rates at one year.
Methods: Organ Procurement and Transplantation Network data was used to identify adult patients who underwent HTx between 01/01/2011 and 06/30/2025 (Single Heart (SH) = 37273, Heart-Kidney (HK) = 2810, Heart-Liver (HLi) = 586, Heart-Lung (HLu) = 483). Baseline characteristics, in-hospital outcomes and one-year survival (adjusted and unadjusted) were compared before and after the allocation system change.
Results: Between 2011 and 2025, 114/152 US HTx centers performed multiorgan HTx. HLi and HLu had higher overall one-year mortality compared to SH (SH: 8.11%; HK: 11.46%, adjusted p=0.1; HLi: 15.36%, p<0.001; HLu: 17.18%, p<0.001). Rates of all types of multiorgan HTx increased in the new allocation era (p<0.01, Figure 1). HK recipients in the new allocation era were more likely to have been on extracorporeal membrane oxygenation (ECMO) support at the time of HTx (1% vs 6.5%, p<0.001) and had shorter waitlist time (87 vs 36 days, p<0.001). While dialysis before discharge (28.6% vs 37.2%, p<0.001) and longer inpatient stay (20 vs 21 days, p=0.005) were more prevalent in the new era, one-year mortality remained unchanged (11.8% vs 11.3%, adjusted HR: 0.92 [0.71-1.18], p=0.5). In the new allocation era, HLi recipients were older (44 vs 49 years, p<0.001), more likely to be on ECMO support (0.6% vs 5.4%, p=0.013), and had fewer waitlist days (109 vs 60, p<0.001). Like HK, HLi showed increased rates of post-HTx dialysis (23% vs 36%, p=0.003) and length of stay (23 vs 28 days, p=0.003), but no significant difference in adjusted one-year mortality (10.9% vs 17.3%, HR: 1.68 [0.95-2.97], p=0.07). HLu recipients in the new allocation era were more frequently on ECMO (16.2% vs 28.8%, p=0.003) and had a shorter waitlist time (72 vs 41 days, p=0.002). In-hospital outcomes and one-year mortality were comparable between the allocation eras (19.8% vs 15.8%, HR 0.77 [0.48-1.22], p=0.268).
Conclusions: The new allocation system achieved an increase in multiorgan HTx in patients with higher clinical acuity and a significant reduction in waitlist time while maintaining survival rates at one year.
ADULT CARDIAC:
Cardiac Transplant and Mechanical Circulatory Support
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