Abstract
BACKGROUND: In the United States, outcomes of adult heart transplant are not well studied in those living in states without an active transplant program. METHODS: Adult heart transplant patients were identified using the United Network of Organ Sharing database (2014-2023). Two groups were formed: out-of-state (OOS) for those in states without a program and in-state (IS) for those with a program. The primary outcome is post-transplant survival. Secondary outcomes examine listing characteristics and patterns using the Center for Disease Control WONDER database. RESULTS: The OOS group (14 states) had 1,561 patients, with Nevada having the highest proportion. Fewer non-White individuals and those with government-sponsored insurance programs were in the OOS group (p < 0.05). Additionally, more patients in the OOS moved out of their primary state residence at the time of transplant (9.3% vs 2%, p < 0.01). Most patients traveled to high-volume centers in neighboring states to be listed. There was no difference in waitlist outcome (p = 0.13), but post-transplant survival was slightly higher in the OOS group (p = 0.04). Fewer patients in the OOS group were listed relative to their state population and the heart failure mortality cohort compared to those in the IS group (p < 0.01). CONCLUSIONS: Overall, the outcomes for individuals living in states without a transplant program did not differ compared to those in states with a program. However, variations in listing characteristics and patterns suggest a potential geographical disparity. Policy changes are crucial to address these inequalities and improve access to heart transplants in states that lack a transplant program.