Background: Current organ allocation policy and the rapid growth of mechanical support favor heart transplant (HT) candidates on left ventricular assist devices. HT candidates with hypertrophic cardiomyopathy (HCM) are usually not left ventricular assist device candidates and may have a disadvantage compared with dilated forms of cardiomyopathy.

Methods and Results: Adult HT candidates registered in the Scientific Registry of Transplant Recipients database between 1999 and 2016 were included. HCM candidates were compared with ischemic cardiomyopathy (ICM) and non-ICM patients. Two eras were defined on the basis of the approval date of the first continuous-flow left ventricular assist device for bridge-to-transplant in the United States (2008). Patients outcomes were evaluated while on the waitlist and after HT. The proportion of patients with HCM listed for HT increased by 44% in era 2 compared with era 1. Waitlist mortality in patients with ICM (15.5%–8.7%) and non-ICM (14.2%–8.2%) declined across eras, but minimal decline was observed in HCM patients (11.7%–9.6%; P=0.06). In era 2, the 12-month rate of HT in HCM (64.8%) was comparable to that of ICM (60.9%) and non-ICM (62.7%) patients (P=0.06). Post-transplant survival in HCM patients was the most favorable in the most recent era (1 year: 91.6% and 5 years: 82.5%; P<0.05 for all comparisons).

Conclusions: The number of patients with HCM in need of HT is increasing. Although post-transplant survival in HCM is excellent, waitlist mortality is substantial and with minimal decline in the most recent era, despite the frequent use of listing status upgrade by exception in this patient cohort. Different strategies to improve the performance of the organ allocation system in patients with HCM are needed.

背景：当前的器官分配政策和机械支持的快速增长有利于左心辅助设备上的心脏移植（HT）候选人。肥厚型心肌病（HCM）的HT候选者通常不是左心室辅助装置的候选者，与扩张型心肌病相比可能有缺点。

方法和结果：纳入了1999年至2016年间在“移植收件人科学注册”数据库中注册的成人HT候选人。将HCM候选者与缺血性心肌病（ICM）和非ICM患者进行比较。根据美国首个用于桥连移植的连续流左心室辅助设备的批准日期（2008年），定义了两个时代。在候补名单上和HT后评估患者的预后。与第1代相比，第2代中被列为HT的HCM患者比例增加了44％，ICM（15.5％–8.7％）和非ICM（14.2％–8.2％）患者的候诊死亡率在各个时代有所下降，但在HCM患者中观察到最小的下降（11.7％–9.6％；P= 0.06）。在第2代中，HCM的12个月HT率（64.8％）与ICM（60.9％）和非ICM（62.7％）患者相当（P = 0.06）。在最近的时期中，HCM患者的移植后存活率最高（1年：91.6％； 5年：82.5％；所有比较的P <0.05）。

结论：需要HT的HCM患者数量正在增加。尽管HCM的移植后存活率很高，但尽管这个患者队列中经常使用列表状态升级，但候补死亡率却很高，并且在最近的一个世纪中下降幅度很小。需要不同的策略来改善HCM患者的器官分配系统的性能。