IMPORTANCE Wide state-level variability in waiting list outcomes have been noted for patients listed for heart transplant in the US, but little is known regarding center-level transplant rates since the heart allocation policy change. OBJECTIVE To evaluate center-level transplant rates following the recent allocation policy change for heart transplant. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the United Network for Organ Sharing database from October 18, 2015, to March 1, 2020, for a nationwide analysis of transplant centers in the US. Transplant candidates were stratified into 2 time cohorts, with era 1 denoting the 3-year period before the policy change (October 18, 2018), and era 2 representing the 500-day period after the policy change but before the beginning of the COVID-19 pandemic. Data were analyzed from May to June 2021. EXPOSURE The heart allocation policy change enacted on October 18, 2018. MAIN OUTCOMES AND MEASURES Competing risk regression for waiting list outcomes was performed to calculate adjusted era 1 and era 2 center-level transplant rates. Rates were compared across regions and states, as well as within organ procurement organizations. Pearson correlation coefficient was used to assess center-level factors associated with era 2 transplant rates. RESULTS Of 15 940 transplant candidates included for analysis, 5063 (median [IQR] age, 56 [45-63] years; 1385 women [27.4%]) comprised the era 2 cohort. The proportion of patients with temporary mechanical circulatory support increased between era 1 and era 2 (extracorporeal membrane oxygenation, 2.00% vs 3.42%; percutaneous ventricular assist device, 0.66% vs 1.86%; intra-aortic balloon pump, 5.21% vs 13.10%). The adjusted mean center-level likelihood of transplant increased after the rule change (from 48.1% in era 1 to 78.0% in era 2). Significant variation in transplant rates was observed across regions and states even among centers with shared organ procurement organizations. The largest absolute difference in transplant rates was 27.1% for 2 centers belonging to the same organ procurement organization. Centers with higher transplant volumes in era 2 and with a greater proportion of candidates with intra-aortic balloon pump were observed to have higher transplant rates. CONCLUSIONS AND RELEVANCE Despite sharing organ supply and having a small geographical distance, these findings suggest that intercenter disparities in the likelihood of transplant have persisted following the heart allocation policy change. Further work is necessary to ensure equitable allocation of organs in heart transplant.

中文翻译：

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心脏分配政策变化后移植率的中心水平变化。

重要性 已注意到在美国接受心脏移植的患者在等候名单结果方面存在广泛的州级差异，但自心脏分配政策发生变化以来，人们对中心级移植率知之甚少。目的 评估近期心脏移植分配政策变化后的中心级移植率。设计、地点和参与者 这项队列研究使用了 2015 年 10 月 18 日至 2020 年 3 月 1 日期间器官共享联合网络数据库中的数据，对美国移植中心进行了全国性分析。移植候选者被分为 2 个时间组，第 1 代表示政策变更前的 3 年期间（2018 年 10 月 18 日），第 2 代代表政策变更后但 COVID-开始前的 500 天期间19大流行。分析了 2021 年 5 月至 6 月的数据。曝光于 2018 年 10 月 18 日颁布的心脏分配政策变更。主要结果和措施 对等候名单结果进行竞争风险回归，以计算调整后的第 1 代和第 2 代中心级移植率。对不同地区和州以及器官采购组织内部的比率进行了比较。Pearson 相关系数用于评估与第 2 代移植率相关的中心级因素。结果 在纳入分析的 15940 名移植候选者中，5063 名（中位 [IQR] 年龄，56 [45-63] 岁；1385 名女性 [27.4%]）构成了时代 2 队列。在第 1 代和第 2 代之间，接受临时机械循环支持的患者比例增加（体外膜肺氧合，2.00% 对 3.42%；经皮心室辅助装置，0.66% 对 1.86%；主动脉内球囊泵，5.21% 对 13.10%）。规则改变后，调整后的平均中心水平移植可能性增加（从第 1 代的 48.1% 到第 2 代的 78.0%）。在不同地区和州甚至在具有共享器官采购组织的中心之间观察到移植率的显着差异。属于同一器官获取组织的2个中心移植率的最大绝对差异为27.1%。观察到第 2 代移植量较高且主动脉内球囊泵候选者比例较高的中心具有较高的移植率。结论和相关性 尽管共享器官供应并且地理距离很小，这些发现表明，随着心脏分配政策的改变，移植可能性的中心间差异持续存在。有必要开展进一步的工作以确保心脏移植中器官的公平分配。