Abstract
The UNOS heart transplant allocation policy implemented in 2018 led to significant improvements in waitlist outcomes, but disparities persist. Our study evaluated the effect of the implementation of the new allocation on waitlist and post-transplantation outcomes in rural versus urban communities. Patients registered for HT in the UNOS database between January 1, 2014, and December 31, 2021, were included as rural or urban according to ZIP code. The cumulative incidence (CI) of death/delisting and transplantation in the different allocations were calculated. Post-transplant survival was calculated using Kaplan-Meier methodology. 26,450 patients were listed for transplant. Rural residents were more commonly white and had a higher incidence of ischemic cardiomyopathy. In the prior allocation, no differences existed in the CI of death/delisting or transplantation between rural and urban residents. In the current allocation, rural residents had a higher frequency of death/delisting (p=0.01) after adjusting for risk factors. No differences existed in the CI of transplantation or post-transplant survival. Our findings suggest rural residence is associated with a higher CI of death/delisting on the transplant list in the current allocation. We found no differences in the CI of transplantation or survival after transplant.