An Investigation of Outcomes with the Donor Heart Allocation System in China

Omni King Edward Hotel 

Objective: The Heart Allocation and Shared Core Policy in China have been implemented for more than three years. The aim of this study was to examine the impact of the heart allocation scheme in the China by analyzing and comparing the data from two eras and evaluating the post-transplant outcomes for patients in urgent and non-urgent status.
Methods: Data on all heart transplant recipients in the four years before (Era 1: January, 2015 to December, 2018) and after (Era 2: January, 2019 to December, 2021) the introduction of the policy were extracted from the China Heart Transplant Registry System and analyzed using Kaplan-Meier analysis and logistic regression analysis.
Results: There were 1583 heart transplantations in Era 1 and 1974 in Era 2. In Era 2, there were 1426 patients had been transplanted in non-urgent status (72.2%) and 548 HTx patients had been transplanted in urgent status (27.8%). As to the categories of urgent status in Era 2, the most common indication for urgent status was IABP (25.0%) and ECMO (24.5%), followed by MCS related complications (23.5%), pediatric urgent status (17.5%) and ventilator dependence (7.8%), and the least was LVAD (1.7%). The overall hospital mortality was not statistically different between two eras, with 8.4% in Era 1 and 9.6% in Era 2 (P=0.21). The overall hospital mortality was significantly higher in urgent status group, with 14.1% in urgent status and 7.9% in non-urgent status (P<0.01). The overall 1-year survival rate significantly decreased from 86.9% to 81.6% between Era 1 and Era 2 (P < 0.01). For urgent recipients during Era 2, 1-year survival was 77.4%, was significantly lower than that of non-urgent status (83.2%, P < 0.01). Factors independently associated with 1-year mortality in patients with urgent status were pre-HTx ECMO support, a lower baseline eGFR (<60 mL/min/1.73 m2), pretransplant CRRT support, donor age≥55 years.
Conclusions: The introduction of the heart allocation scheme in the China has increased the efficiency of donor heart allocation and the utilization rate of donor heart nationwide that has been a great improvement in the number of HTx in China after the heart allocation scheme. Considering the increasing complexity of recipients and donors, a 5% decrease in one-year post-transplant survival rate between the 2 eras is acceptable. The Heart Allocation and Shared Core Policy in China has been proved be feasible preliminarily.

Authors
Shan Zheng (1), Sheng Liu (2), Zhe Zheng (3)
Institutions
(1) Fuwai Hospital, Beijing, Beijing, (2) Fuwai Hospital, Beijing, NA, (3) Fuwai Hospital, Beijing, CA