{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T04:46:18Z","timestamp":1792817178509,"version":"4.5.0"},"reference-count":24,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T00:00:00Z","timestamp":1693267200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>United Network for Organ Sharing (UNOS) allocation criteria changed in 2018 to accommodate the increased prevalence of ventricular assist device use as a bridge to heart transplant, which consequently prioritized sicker patients. We aimed to assess the impact of this new allocation policy on the length of stay following heart transplantation. Secondary outcomes include other risk factors for prolonged hospitalization and its effect on mortality and postoperative complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The UNOS Registry was queried to identify patients who underwent isolated heart transplants in the United States between 2001 and 2023. Patients were divided into quartiles according to their respective length of stay.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 57\u00a0020 patients were included, 15\u00a0357 of which were allocated with the new system. The median hospital length of stay was 15 days (mean 22.7 days). Length of stay was longer in the new allocation era (25\u00a0\u00b1\u00a030\u00a0vs. 22\u00a0\u00b1\u00a027 days, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001). The longer length of stay was associated with increased 5\u2010year mortality in the new allocation system (aHR: 1.18; 95% CI: 1.15, 1.20; <jats:italic>p<\/jats:italic>\u2010value:\u00a0&lt;\u00a0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Longer hospital stays and associated observed increased risk for mortality in the era after the allocation criteria change reflect the rationale of this shift which was to prioritize heart transplants for sicker patients. Further studies are needed to track the progress of surgical and perioperative management of these studies over time.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.15114","type":"journal-article","created":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T07:28:45Z","timestamp":1693294125000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Impact of new allocation system on length of stay following heart transplantation in the United States"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4128-7111","authenticated-orcid":false,"given":"Ilias P.","family":"Doulamis","sequence":"first","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Surgery Lahey Hospital and Medical Center  Burlington MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2902-7947","authenticated-orcid":false,"given":"Marco","family":"Gemelli","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Rempakos","sequence":"additional","affiliation":[{"name":"Medical School of Athens National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aspasia","family":"Tzani","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital Heart and Vascular Center Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas A.","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery Heart, Vascular, and Thoracic Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8352-5360","authenticated-orcid":false,"given":"Polydoros","family":"Kampaktsis","sequence":"additional","affiliation":[{"name":"Division of Cardiology Columbia University Irving Medical Center  New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvise","family":"Guariento","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Cardiac Surgery Unit Department of Cardiac Thoracic, Vascular Sciences and Public Health University of Padua  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiki","family":"Kuno","sequence":"additional","affiliation":[{"name":"Department of Cardiology Montefiore Medical Center Albert Einstein College of Medicine  New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulino","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Division of Cardiology Cleveland Clinic Foundation  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5740-9670","authenticated-orcid":false,"given":"Alexandros","family":"Briasoulis","sequence":"additional","affiliation":[{"name":"Medical School of Athens National and Kapodistrian University of Athens  Athens Greece"},{"name":"Division of Cardiovascular Medicine Section of Heart Failure and Transplantation University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,29]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001123"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2022.02.010"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l223"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2017.02.020"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2020.01.014"},{"key":"e_1_2_7_7_1","unstructured":"Thoracic Organ Transplantation Committee U: OPTN\/UNOS policy notice proposal to modify the adult heart allocation System A (RRB and Committee Review of Exceptions) 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