WEDNESDAY, Dec. 16, 2020 — There is significant state-level variation for outcomes among patients listed for heart transplantation in the United States, according to a study published online Dec. 9 in JAMA Network Open.

Emmanuel Akintoye, M.D., from the University of Iowa Hospitals and Clinics in Iowa City, and colleagues evaluated state-level variation in outcomes of 15,036 adult patients listed for heart transplantation (status 1A) identified from the United Network for Organ Sharing database (2011 through 2016).

The researchers found that 14.3 percent of patients died while on the waitlist, and 73 percent received transplants. The median time on the waitlist for those who received transplants was 31 days. The range for waitlist mortality was 1.0 to 7.8 deaths per 1,000 waitlist person-days, 5.6 to 34.5 transplants per 1,000 waitlist person-days for transplant rate, and 87 to 92 percent for risk-adjusted one-year graft survival. There was significant state-level variation noted when comparing the highest and lowest quartiles for waitlist mortality (hazard ratio, 1.53), transplant rate (hazard ratio, 1.57), and one-year graft survival (odds ratio, 2.07).

“Identifying and addressing the factors associated with these geographic variations in outcomes is important to ensure a fair allocation system,” the authors write.

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