OPTN/SRTR 2022 Annual Data Report: Heart

Monica M. Colvin^1,2, Jodi M. Smith^1,3, Yoon Son Ahn¹, Dzhuliyana K. Handarova⁴, Alina C. Martinez⁴, Kelsi A. Lindblad⁴, Ajay K. Israni^1,5,6, Jon J. Snyder^1,5,6

¹Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN

²Department of Cardiology, University of Michigan, Ann Arbor, MI

³Department of Pediatrics, University of Washington, Seattle, WA

⁴Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA

⁵Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN

⁶Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN

Abstract

The number of heart transplants in the United States has continued to increase. Since 2011, pediatric heart transplants have increased 31.7% to 494 and adult heart transplants have increased 85.8% to 3,668 in 2022. The numbers of new candidates for pediatric and adult heart transplants have also increased, with 703 new pediatric candidates and 4,446 new adult candidates in 2022. Adult heart transplant rates continue to rise, peaking at 122.5 transplants per 100 patient-years in 2022; however, the pediatric heart transplant rate decreased to its lowest rate in the past decade, 104.2 transplants per 100 patient-years, a decrease of 13.9% from 121 transplants per 100 patient-years in 2011. Despite this, pretransplant mortality among pediatric candidates has decreased by 52.2%, from 20.8 deaths per 100 patient-years in 2011 to 10.0 deaths per 100 patient-years in 2022, but remains excessive for candidates younger than 1 year at 25.7 deaths per 100 patient-years. Among adult candidates, pretransplant mortality declined from 15 deaths per 100 patient-years in 2011 to 8.7 deaths per 100 patient-years in 2022. Since 2011, posttransplant mortality has been stable to slightly better; among recipients who underwent transplant in 2015-2017, the 1-, 3-, and 5-year pediatric survival rates were 93.7%, 89.2%, and 85.0%, respectively, and the adult survival rates were 91.3%, 85.7%, and 80.4%. Donor trends have been favorable, with an increase in the numbers of hearts recovered and growing numbers of hearts procured after circulatory death.

Keywords: Allocation, donor, heart failure, heart transplant, left ventricular assist device, mechanical circulatory support, outcomes

1 Introduction

Heart allocation policy, particularly the adult heart allocation policy, has evolved and has universally changed practice.¹^,² Although the 2018 policy may have contributed to better access and faster transplant rates,³ particularly in high-urgency candidates, and lower overall pretransplant mortality rates, the policy changes inadvertently promoted short-term circulatory support devices as a means to transplant⁴^,⁵ and resulted in excessive requests for exceptions.⁶ Despite increased transplant rates among candidates listed at statuses 1 and 2, pretransplant mortality, which was previously declining, increased between 2021 and 2022, a concerning signal. Nevertheless, the promise of continuous distribution and a points-based allocation policy may help to mitigate some of the unintended consequences of the policy by removing hard boundaries for listing and for moving to a higher status, and by providing weights to clinically relevant attributes. The Annual Data Report provides an evaluation of trends in adult and pediatric heart transplant waiting lists, donation, transplants, and outcomes in the United States. This year, the race and ethnicity category has been expanded to include Multiracial and Native American, and limited data are available for hearts recovered after circulatory death. Inherent differences in calculations during 2018 should be considered when assessing status-specific rates obtained during 2018 among adult candidates and recipients. As a result, trends in adult heart transplant that are stratified by status are compared to 2019 as opposed to 2018 where appropriate.

2 Adult Heart Transplant

2.1 Adult Waitlist Trends

In 2022, 4,446 new adult heart candidates were added to the heart transplant waiting list; a total of 7,519 candidates aged 18 years and older were awaiting heart transplant, a 28.1% increase from 5,869 candidates in 2011 (Figure HR 1 and Figure HR 2). The largest adult age group on the waiting list in 2022 continues to be 50-64 years (46.7%), followed by 35-49 years (21.7%), 65 years or older (20.3%), and 18-34 years (11.3%) (Figure HR 3). Over the past decade, the proportion of all racial and ethnic groups increased except for White, which decreased by 18.4%, and Multiracial, which remained constant (Figure HR 5). In 2022, more than half of adult heart transplant candidates were White (56.3%), 28.2% were Black, 10.8% were Hispanic, 3.8% were Asian, and 0.4% were Native American; 0.5% identified as Multiracial (Figure HR 5). Cardiomyopathy continued to be the leading diagnosis among adult heart transplant candidates, at 60.2% in 2022, which is an increase of 18.7% since 2011. The proportion of adults awaiting transplant for coronary artery disease has declined by 28.2% over the past decade (Figure HR 6). Time on the waiting list, which is determined by the earliest of transplant, death, removal, or December 31 of the year, appears to be decreasing, with 45.8% of candidates waiting less than 90 days, an increase of 54.5% since 2011. There was an appreciable increase in waiting times of less than 90 days while longer waiting times decreased (Figure HR 7).

More than half (61.6%) of adult heart transplant candidates lived less than 50 miles from the transplant center in 2022 (Table HR 1). The proportion of candidates on the waiting list with a ventricular assist device at listing increased from 22.4% in 2012 to 35.0% in 2022 (Table HR 2). On December 31, 2022, almost half of candidates, 47%, were awaiting transplant as status 4; the second largest group was waiting as status 6, 19.9% (Table HR 2). Between 2021 and 2022, there were increases in candidates awaiting heart transplant as status 1 and status 2 in all regions except regions 6, 7, and 9, where status 1 candidates decreased or remained constant. In 2022, the proportion of candidates awaiting transplant as status 1 ranged from 4.3% to 7.5% across regions and from 20.5% to 33.5% for status 2 (Table HR 4). There has been an increase in both waitlist removals and candidates added to the waiting list between 2020 and 2022; however, removals have exceeded additions, resulting in a decline in candidates on the list at the end of the year (Table HR 5). Since 2019, the first full year of the new heart allocation policy, the proportion of candidates awaiting transplant at statuses 1, 2, 5, and 6 has increased by 1.9%, 7.7%, 0.5%, and 1.8%, respectively, while there has been a decrease in candidates at statuses 3 and 4, by 3.2% and 4.5%, respectively (Figure HR 9). Among the candidates removed from the waiting list in 2022, 3,652 (78.7%) were removed due to transplant, 171 (3.7%) died, 157 (3.4%) were removed due to improved condition, and 212 (4.6%) were considered too sick to undergo transplant (Table HR 6).

2.2 Adult Heart Transplant Rates

Transplant rates have been increasing since 2015, and in 2022, the overall transplant rate was 122.5 transplants per 100 patient-years; this is an increase of 81.8% since 2011, when the rate was 67.4 transplants per 100 patient-years (Figure HR 13). Similar increases were seen in all age groups, with the greatest increase occurring in candidates aged 18-34 years. Candidates aged 65 years or older received transplants most rapidly at 138.8 transplants per 100 patient-years in 2022 (Figure HR 14). Regarding race and ethnicity, candidates in the Asian category underwent transplant at the highest rate, at 175.6 transplants per 100 patient-years, followed by those in the Hispanic, White, Black, and Other categories. In all categories, there was an increase in transplant rate since 2011, with the greatest change, 173.4%, occurring in the category classified as Other (Figure HR 15). By diagnosis, candidates with valvular heart disease had the highest transplant rate (145.6 transplants per 100 patient-years), followed by cardiomyopathy, Other/unknown, coronary artery disease, and congenital heart disease (128.7, 122.9, 113.5, and 98.0 transplants per 100 patient-years, respectively) (Figure HR 16). The transplant rate for all blood types continues to increase, with the greatest increase since 2011 (110%) occurring in blood type A. The transplant rate for blood type AB increased 89% since 2018 and remains the highest rate of all blood types, at 376.6 transplants per 100 patient-years in 2022, more than twice that of blood type A, which has the second highest transplant rate (Figure HR 17). The transplant rate among women exceeds that of men: 143.1 versus 116.4 transplants per 100 patient-years (Figure HR 18). Since 2019, transplant rates have declined slightly for statuses 1 and 2 and increased for the other active statuses (Figure HR 20). Status 1 candidates continue to have the highest rate of transplant: 1,640 transplants per 100 patient-years in 2022. Most patients who were newly listed in 2019 underwent transplant within the first year of listing (63.8%); by 3 years, 71.8% had undergone transplant, 6.5% were still waiting, 4.0% had died, and 17.7% were removed for other reasons (Figure HR 23).

2.3 Adult Pretransplant Mortality

Overall pretransplant mortality declined from 15 deaths per 100 patient-years in 2011 to 8.7 deaths per 100 patient-years in 2019 and has remained at a plateau in 2022 (Figure HR 25). Since 2011, pretransplant mortality has declined for all age groups but remains highest for persons aged 65 years or older, at 14.4 deaths per 100 patient-years in 2022 (Figure HR 26). Pretransplant mortality declined for all race and ethnicity categories since 2011 except for Asian. Candidates in the Asian category had slightly higher pretransplant mortality in 2022, at 9.7 deaths per 100 patient-years, compared with 8.5 deaths per 100 patient-years in 2012, while pretransplant mortality decreased substantially in other race and ethnicity categories (Figure HR 27). Candidates with congenital heart disease had the greatest improvement in pretransplant mortality rate, with a decline of 51.3% since 2011 to 6.2 deaths per 100 patient-years in 2022, the lowest of all the diagnoses. Pretransplant mortality increased 50.1% in the valvular heart disease group, from 8.77 deaths per 100 patient-years in 2011 to 13.2 deaths per 100 patient-years in 2022. This was second to candidates classified with an “Other/unknown” diagnosis, who had the highest pretransplant mortality in 2022: 15.7 deaths per 100 patient-years (Figure HR 29).

Following the 2018 heart allocation policy, there was an increase in the prevalence of short-term circulatory support devices prior to transplant.⁴ In 2022, the proportion of patients on any life support declined to 74.4% compared with 82.3% in 2019. There was an increase in use of all circulatory support devices, except for total artificial heart, which declined to only eight cases in 2022 (Table HR 7). The OPTN policy to collect data on Impella 5.5 became effective on August 16, 2023; therefore, this device is not included in this analysis.

Since 2019, pretransplant mortality increased among candidates listed at statuses 1, 2, and 3 and improved in those listed as statuses 4, 5, and 6 (Figure HR 32). Pretransplant mortality among status 1 candidates had declined to 81.2 deaths per 100 patient-years in 2021, but increased again to 143 deaths per 100 patient-years in 2022, which far exceeds that of candidates listed as status 2 (46.0 deaths per 100 patient-years). Candidates listed as status 6 had the lowest pretransplant mortality rate in 2022 (3.6 deaths per 100 patient-years), followed by status 4 (4.8 deaths per 100 patient-years). Candidates listed as status 5 continue to have a higher pretransplant mortality rate (10.4 deaths per 100 patient-years) than candidates listed at status 4 (Figure HR 32). While there remains concern in the community regarding the slower rate of transplant for candidates listed as status 4, namely those with a left ventricular assist device, the rate of transplant does not appear to affect mortality among candidates listed as status 4. Candidates listed as status 4 had the second lowest pretransplant mortality, while pretransplant mortality continues to be highest among the statuses associated with hemodynamic instability or multiorgan failure (statuses 1, 2, 3, and 5) (Figure HR 32). Pretransplant mortality rates in 2022 varied widely by donation service area: from 0 to 44.92 deaths per 100 patient-years, with a mean of 9.6 deaths per 100 patient-years (Figure HR 33).

Deaths within 6 months of removal from the transplant list for reasons other than transplant or death have declined since 2011, although these percentages slightly increased from 11.5% in 2021 to 14.8% in 2022 (Figure HR 34). Death within 6 months of removal was highest in 2022 among candidates aged 65 years or older (23.7%) and lowest among candidates aged 18-34 years (7.0%) (Figure HR 35). In 2022, Asian candidates had the highest percentage of death within 6 months of removal; there was a 62% increase from 2011 (14.3%) to 2022 (23.1%). Death within 6 months of removal also increased for candidates in the Hispanic category and declined for those in the Black, White, and Other categories (Figure HR 36). Death within 6 months of removal from the list also increased among candidates listed as status 1, from 15% in 2019 to 44.4% in 2022, while decreasing in all other statuses. Death within 6 months of removal was second highest in temporarily inactive candidates (16.5%), followed by candidates listed as status 5 (11.1%) (Figure HR 38).

2.4 Trends in Donor Hearts

The number of deceased donor hearts recovered for transplant (including adult and pediatric) continues to rise, and in 2022, reached 4,223, a 77.4% increase from 2,380 in 2011 (Figure HR 39). The largest annual increase, 384 donors, occurred from 2015 to 2016, followed by 323 from 2021 to 2022. The greatest increase in donors from 2011 to 2022 occurred in those aged 30-39 years, from 461 to 1,353 (a 194% increase); this approximates the number of donors aged 18-29 years, which reached 1,432 in 2022 and is typically the largest donor age group. There has also been a 78% increase in donors aged 40-54 years, from 479 in 2011 to 851 in 2022, while the number of donors aged 55 years or older declined to 47 in 2022 from 58 in 2011, following a peak of 97 in 2019 (Figure HR 40). In 2022, the age group 18-29 years comprised 33.9% of donors, followed by age group 30-39 years, which comprised 32% of donors (Figure HR 41). There were no major changes in donor distributions by race and ethnicity or sex (Figure HR 42 and Figure HR 43). Donors who were hepatitis C virus positive increased substantially from 2011 to 2022 (11,763%) and reached a plateau of about 10% of all donors in 2019 through 2022 (Figure HR 44).

In 2022, 8.8% of the hearts recovered for transplant were procured after circulatory death (ie, donation after circulatory death [DCD]), a substantial increase from 0.04% in 2011 and 0.0% in 2018, from which time there has been a steady increase (Figure HR 45). In 2019, anoxia emerged as the leading cause of death for heart donors and continues to increase in prevalence; in 2022, 48.5% of heart donors died from anoxia (Figure HR 46). Nonuse of recovered hearts remains uncommon but is at the highest level this decade at 1.3%, a value twice that of 2011 (Figure HR 47). Most of the unused hearts are from donors aged 55 years and older (6.4%), while less than 1% of unused hearts are from donors younger than 18 years (Figure HR 48). Since 2011, rates of nonuse have increased among all race and ethnicity groups except Other, and most notably among Hispanic donors. The highest nonuse rate in 2022 is among Asian donors (2.7%), followed by Black donors (1.9%), Hispanic donors (1.5%), White donors (1%), and donors in the Other category (0%) (Figure HR 50). Hearts from donors with hypertension continue to be unused at higher rates than from those without hypertension: 1.7% versus 1.2% in 2022. This nonuse of hearts from donors with hypertension is overall lower since 2011, while nonuse of hearts from donors without hypertension appears to be increasing (Figure HR 51). Regarding donor causes of death, hearts from donors who died of cerebrovascular accident/stroke were the most often not used in 2022 (2.5%), followed by head trauma (1.3%); nonuse in both groups has increased tremendously since 2011 (increases of 92.2% and 740.5%, respectively). Donors whose cause of death was classified as Other/unknown have had widely fluctuating nonuse rates, with a peak of 3.3% in 2017 and a low of 0% in some years, including 2022 (Figure HR 53). These fluctuations may be due to variations in categorization or due to sample size. Nonuse rates among donors with standard risk of disease transmission and those with increased risk of disease transmission have fluctuated, and in 2022, nonuse rates among standard-risk donors were higher than those among increased-risk donors (1.5% versus 0.6%) (Figure HR 54).

2.5 Adult Heart Transplant Trends

Mirroring the increase in donors, heart transplants in the United States continue to gradually increase, with 3,668 adult heart transplants achieved in 2022 (Figure HR 55). In 2022, most adult heart transplant recipients were aged 50-64 years (46.6%). The number of recipients aged 65 years or older and 18-34 years increased 122.1% and 104.9%, respectively, since 2011 (Figure HR 56). The proportion of male recipients has increased faster than that of female recipients, and in 2022, there were 2,680 heart transplants performed in men compared with 988 in women (Figure HR 57). Between 2011 and 2022, the numbers of heart transplants increased in all race and ethnicity groups. This year, we have also added Native American as a category, and in 2022, there were 14 Native American heart transplant recipients compared to 1 reported cased in 2011 (Figure HR 58). The number of recipients who received transplants for cardiomyopathy continues to increase; however, the greatest changes occurred in congenital heart disease, increasing 149.3% between 2011 and 2022 (from 75 to 187), and in Other/unknown, which increased 381.8% (from 22 to 106). In 2022, there were 2,350 heart transplants performed in patients with cardiomyopathy compared to 950 in those with coronary artery disease, the next highest category, while only 39 transplants were performed for valvular heart disease (Figure HR 59). Since 2019 (the first full year after the 2018 heart allocation policy), there have been increases in transplants in all urgency categories except status 3, which declined 26.7%: from 644 recipients in 2019 to 472 in 2022 (Figure HR 60).

In 2022, 14.0% of heart transplants were combined with transplant of other organs compared with 5.7% in 2011. Multiorgan transplant has increased more rapidly than heart transplant alone. From 2011 to 2022, heart-kidney transplants increased 442.3%, from 71 to 385. Similarly, heart-liver transplants increased 393.3% (from 15 to 74) and heart-lung increased 87.5% (from 24 to 45), while heart-alone transplant increased by only 69.4% (Figure HR 61).

The demographic characteristics of the typical heart transplant recipient—White, male, 50-64 years—have not shifted substantially since 2012; however, there is an increasing prevalence of younger (18-34 years) and older (65+ years) recipients, more racial and ethnic diversity, and a more diverse payer mix, with an increase in Medicare and Medicaid and a decline in private payers from 50.9% to 44.8%. Most recipients reside within 50 miles of their transplant center, although there has been a slight decline since 2012 (Table HR 8). Most recipients have a calculated panel-reactive antibody (cPRA) value of <1%. It is noteworthy that in 2022, 27.2% of recipients had missing cPRA values. Most recipients (52.2%) were listed as status 2 at the time of transplant (Table HR 9). In 2022, 69.8% of patients waited fewer than 90 days (waiting time of 0 days and <90 days) for heart transplant compared with 50.0% in 2012 (Table HR 10). This was mirrored by a decrease in longer waiting times, although waiting time of 2 or more years changed minimally.

2.6 Adult Posttransplant Survival and Morbidity

Posttransplant mortality has been stable to slightly better since 2011, except for 10-year mortality, which increased slightly from 35.7% in 2011 to 37.4% in 2012. In 2022, 6-month and 1-year mortality were 7.3% and 9.2%, respectively. Three-year mortality was 15.3% and 5-year mortality was 19.9% (Figure HR 64). Early reductions in survival were seen in age groups older than 34 years, most notably in the 65 years or older group; by 6 months, survival among recipients who received a heart in 2015-2017 was 90.7% in recipients 65 years or older compared with 95.1% in those aged 18-34 years. This trend continued until year 2, after which there was a more pronounced decline in survival for recipients aged 18-34 years relative to the other age groups. By year 5, survival was slightly lower in recipients aged 18-34 years (78.9%) and 65 years or older (77.8%) compared with the other age groups (35-49 and 50-64 years, 82.1% and 81.0%, respectively) (Figure HR 66).

Early survival among recipients who received a heart in 2015-2017 declined more rapidly in the Native American category compared with other race and ethnicity groups, and by 3 months, was 88.0% compared with 92.0%-96.6% in the other categories; this may be affected by the low numbers of Native American transplant recipients. One-year mortality ranged from 88.0% to 92.3% among the race and ethnicity groups. Hispanic recipients also had early declines in mortality. By year 5, survival was highest in recipients categorized as White (81.9%), followed by Asian, Multiracial, Black, Hispanic, and Native American, ranging from 76.0% to 80.4% (Figure HR 67).

Short-term and long-term survival among recipients who received a heart in 2015-2017 were lowest in those with congenital heart disease, reaching 89.7% at 3 months and 75.0% at 5 years. Short-term survival was best among patients with cardiomyopathy, 92.4% at 1 year, but by 5 years, survival in recipients with cardiomyopathy had been surpassed by those with an Other/unknown diagnosis, 82.2% versus 86.6%, respectively (Figure HR 68). Five-year survival in recipients who received a heart in 2015-2017 was slightly worse among patients with a ventricular assist device compared to those without one, at 78.7% versus 82.1%, respectively (Figure HR 70). For the recipients who received a heart in 2019-2020, posttransplant survival was worse at all time points for recipients who underwent transplant at status 5; their survival was only 88.0% at 3 months, compared with 91.7%-95.8% for the other status categories. By 5 years, survival in recipients who underwent transplant at status 5 was only 77.3%, compared with 84.6%-88.7% in the other status groups (Figure HR 72).

Dual organ transplants have increased in heart recipients, and the 5-year survival rate for heart-liver and heart-kidney transplants in 2015-2017 (Figure HR 74) appears comparable to overall heart transplant survival from Figure HR 65. On the other hand, heart-lung continues to have lower survival compared with other heart transplant combinations. Five-year survival for heart-lung transplant is 64.8% and for Other multiorgan transplant is 75% (small numbers), compared with 80.6% for heart-kidney and 82.2% for heart-liver (Figure HR 74). Status 5, the category reserved for multiorgan transplant, tends to have the lowest posttransplant survival of all statuses, which may be driven by heart-lung transplant and Other multiorgan transplant. The decrement in survival for heart-lung transplant occurs during the first month of transplant. By 3 months, 25.0% of Other multiorgan recipients had died, and by 6 months, 14.8% of heart-lung recipients had died. Since 2011, the incidence of acute rejection by 1-year posttransplant has declined for all age groups except recipients aged 65 years or older. The most notable decline, 37% in 2011 to 29% in 2021, occurred in recipients aged 18-34 years, the group with the highest incidence of rejection. Acute rejection was lowest for recipients aged 65 years or older, at 17.9% in 2021, a slight increase from 17.3% in 2011 (Figure HR 75).

3 Pediatric Heart Transplant

3.1 Pediatric Waitlist Trends

In 2022, there were 703 new pediatric candidates added to the heart transplant waiting list, and a total of 1,188 candidates aged 17 years or younger were awaiting heart transplant, which is a 36.7% increase from 2011 (Figure HR 77 and Figure HR 78). The largest pediatric age group on the waiting list in 2022 was 12-17 years (29.0%), followed by 1-5 years (23.6%), younger than 1 year (21.4%), and 6-11 years (20.5%) (Figure HR 79). Almost half of pediatric heart transplant candidates were White (48.1%), 23.7% were Hispanic, 20.2% were Black, 4.2% were Asian, and 0.6% were Native American (Figure HR 80). Looking at changes over the past decade, the proportion of Asian candidates increased by 82.9% since 2011; Hispanic candidates increased by 23.8%, and the proportion of Black candidates has remained constant (Figure HR 80). Congenital defects continued to be the leading diagnosis among pediatric heart transplant candidates, at 60.4% in 2022, an increase of 32.3% since 2011 (Figure HR 81). Almost half, 47.9%, of pediatric heart transplant candidates live less than 50 miles from the transplant center (Table HR 11). The proportion of candidates listed with a ventricular assist device increased from 6.0% in 2012 to 8.6% in 2022 (Table HR 12). Among the 677 candidates removed from the waiting list in 2022, 509 (75.1%) were removed due to undergoing transplant, 48 (7.1%) died, 52 (7.7%) were removed due to improved condition, and 35 (5.2%) were considered too sick to undergo transplant (Table HR 15).

In 2022, 37.5% of pediatric heart transplant candidates on the waiting list had been waiting for less than 90 days, a decrease of 23.7% from 49.1% in 2011 (Figure HR 83). The proportion of candidates waiting 3 to less than 6 months increased by 41.5%, from 14.5% in 2011 to 20.5% in 2022. Almost half (47.1%) of candidates were listed as status 1A in 2022, followed by 19.2% status 1B and 10.9% status 2 (Figure HR 84). Just over 70% of pediatric candidates newly listed during 2017-2019 underwent transplant within 3 years, 9.7% died, 14.8% were removed from the list, and 4.7% were still waiting (Figure HR 85). In 2022, the heart transplant rate decreased to its lowest rate in the past decade, 104.2 transplants per 100 patient-years, which is a decrease of 13.9% from 121 transplants per 100 patient years in 2011 (Figure HR 86).

Transplant rates in 2022 varied by age, with the highest rates for candidates aged 12-17 years (163.5 transplants per 100 patient-years) and younger than 1 year (158.6 transplants per 100 patient-years), followed by 6-11 years (81.4 transplants per 100 patient-years) and 1-5 years (61.0 transplants per 100 patient-years) (Figure HR 87). Over the past decade, transplant rates in candidates younger than 1 year decreased by 41.8%; in those aged 1-5 years, decreased by 37.0%; in those aged 12-17 years, increased by 14.1%; and in those aged 6-11 years, remained relatively constant (Figure HR 87). Transplant rates in 2022 were similar among pediatric waitlist candidates by race and ethnicity (Figure HR 88).

Pretransplant mortality decreased by 52.2% from 2011 to 2022: from 20.8 deaths per 100 patient-years to 10.0 deaths per 100 patient-years (Figure HR 90). Pretransplant mortality rates in 2022 varied by age, with the highest rates in candidates younger than 1 year, at 25.7 deaths per 100 patient-years, followed by those aged 1-5 years, 12-17 years, and 6-11 years at 9.4, 6.5, and 5.1 deaths per 100 patient-years, respectively (Figure HR 91). From 2011 to 2022, pretransplant mortality has decreased in all age groups: by 62.0% among candidates younger than 1 year, by 50.6% among candidates aged 1- 5 years, by 64.5% in candidates aged 6-11 years, and by 35.9% among candidates aged 12-17 years (Figure HR 91). Looking at pretransplant mortality in 2022 by race and ethnicity, rates among Asian, Black, Hispanic, and White candidates were 14.7, 11.4, 10.8, and 8.2 deaths per 100 patient-years, respectively (Figure HR 92). By medical urgency, pretransplant mortality in 2022 was highest for candidates listed as status 1A (24.8 deaths per 100 patient-years), followed by status 1B (5.0 deaths per 100 patient-years) and status 2 (4.8 deaths per 100 patient-years) among active statuses (Figure HR 94). Pretransplant mortality rates were similar for heart transplant candidates listed in metropolitan and nonmetropolitan areas in 2022 (Figure HR 95).

3.2 Pediatric Trends in Heart Transplant

The number of pediatric heart transplants performed increased to 494 in 2022, a 31.7% increase from 2011 (Figure HR 96). There were 192 (38.9%) heart transplants performed in recipients aged 12-17 years, 114 (23.1%) in recipients younger than 1 year, 97 (19.6%) in recipients aged 1-5 years, and 91 (18.4%) in recipients aged 6-11 years (Figure HR 97). Looking at 2022 pediatric heart transplant counts by race and ethnicity, there were 223 heart transplants in White recipients, 126 in Hispanic recipients, 106 in Black recipients, 24 in Asian recipients, 12 in Multiracial recipients, and 3 in Native American recipients (Figure HR 99). Over the past decade, the proportion of transplant recipients aged 12-17 years has increased from 27.7% in 2012 to 38.9% in 2022 (Table HR 17). Just over half of pediatric heart transplant recipients in 2022 had congenital defect as their primary cause of disease, an increase from 44.1% in 2012 to 54.0% in 2022 (Table HR 18). From 2012 to 2022, the proportion who underwent transplant at status 1A declined from 87.4% to 81.2%, whereas the proportion who underwent transplant at status 1B increased from 7.8% to 16.4% and the proportion at status 2 declined from 4.8% to 2.4%. The proportion of pediatric heart transplant recipients with a ventricular assist device at transplant increased from 23.4% in 2012 to 37.7% in 2022 (Table HR 18). The proportion of ABO-incompatible transplants has increased from 3.0% in 2012 to 9.1% in 2022 (Table HR 19).

Over the past decade, induction therapy use has increased, to 83.6% of pediatric heart transplant recipients in 2022 (Figure HR 102). In 2022, for the first time, the initial immunosuppression regimen used most commonly in pediatric heart transplant recipients was tacrolimus and mycophenolate (in 46.4%, an increase of 114.6% since 2011), followed by tacrolimus, mycophenolate, and steroids (in 43.3%) (Figure HR 103).

3.3 Pediatric Posttransplant Survival and Morbidity

Among pediatric heart transplant recipients in 2021, the rate of acute rejection in the first year was 19.6% in recipients aged 12-17 years, 12.5% in those aged 6-11 years, 10.8% in those younger than 1 year, and 10.3% in those aged 1-5 years (Figure HR 104).

Recipient death occurred in 6.1% of patients at 6-months posttransplant and in 8.0% at 1-year posttransplant among pediatric heart transplants performed in 2021, in 11.8% at 3 years for transplants performed in 2019, in 15.7% at 5 years for transplants performed in 2017, and in 22.0% at 10 years for transplants performed in 2012 (Figure HR 106). Overall, 1-, 3-, and 5-year patient survival rates were 93.7%, 89.2%, and 85.0%, respectively, among recipients who underwent transplant in 2015-2017 (Figure HR 107). By age, 5-year patient survival was 83.2% for recipients younger than 1 year, 84.9% for those aged 1-5 years, 87.1% for those aged 6-11 years, and 85.7% for those aged 12-17 years among recipients who underwent transplant in 2015-2017 (Figure HR 108). By etiology of disease, 5-year patient survival was lowest among children with congenital defects at 81.0% and highest for children with idiopathic-related cardiomyopathy at 93.4% (Figure HR 110). By urgency status, the 5-year patient survival was 84.5% for status 1A pediatric recipients, 90.0% for status 1B recipients, and 77.5% for status 2 recipients (Figure HR 111).

Among pediatric heart transplant recipients in 2011-2017, the overall incidence of posttransplant lymphoproliferative disorder was 5.1% at 5 years; the incidence was 6.6% among recipients who were Epstein Barr virus negative and 3.5% among recipients who were Epstein-Barr virus positive (Figure HR 105).

References

Ran G, Chung K, Anderson AS, Gibbons RD, Narang N, Churpek MM, Parker WF. Between-center variation in high-priority listing status under the new heart allocation policy. Am J Transplant. 2021;21:3684-3693. doi:10.1111/ajt.16614

Shore S, Golbus JR, Aaronson KD, Nallamothu BK. Changes in the United States adult heart allocation policy: Challenges and opportunities. Circ Cardiovasc Qual Outcomes. 2020;13:e005795. doi:10.1161/CIRCOUTCOMES.119.005795

Golbus JR, Li J, Cascino TM, Tang W, Zhu J, Colvin M, Walsh MN, Nallamothu BK. Greater geographic sharing and heart transplantation waitlist outcomes following the 2018 heart allocation policy. J Heart Lung Transplant. 2023;42:936-942. doi:10.1016/j.healun.2023.02.003

Golbus JR, Gupta K, Colvin M, Cascino TM, Aaronson KD, Kumbhani DJ, Saran R, Nallamothu BK. Changes in type of temporary mechanical support device use under the new heart allocation policy. Circulation. 2020;142:1602-1604. doi:10.1161/CIRCULATIONAHA.120.048844

Cascino TM, Stehlik J, Cherikh WS, Cheng Y, Watt TMF, Brescia AA, Thompson MP, McCullough JS, Zhang M, Shore S, Golbus JR, Pagani FD, Likosky DS, Aaronson KD. A challenge to equity in transplantation: Increased center-level variation in short-term mechanical circulatory support use in the context of the updated U.S. heart transplant allocation policy. J Heart Lung Transplant. 2022;41:95-103. doi:10.1016/j.healun.2021.09.004

Golbus JR, Ahn YS, Lyden GR, Nallamothu BK, Zaun D, Israni AK, Walsh MN, Colvin M. Use of exception status listing and related outcomes during two heart allocation policy periods. J Heart Lung Transplant. 2023;42:1298-1306. doi:10.1016/j.healun.2023.05.004

Support, Copyright, and Citation Information

This publication was produced for the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), by Hennepin Healthcare Research Institute (HHRI) and the United Network for Organ Sharing (UNOS) under contracts HHSH75R60220C00011 and HHSH250201900001C, respectively.

This publication lists nonfederal resources in order to provide additional information to consumers. The views and content in these resources have not been formally approved by HHS or HRSA. Neither HHS nor HRSA endorses the products or services of the listed resources.

The OPTN/SRTR 2022 Annual Data Report is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. Data are not copyrighted and may be used without permission if appropriate citation information is provided.

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Suggested Citations:

Full citation: Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2022 Annual Data Report. U.S. Department of Health and Human Services, Health Resources and Services Administration; 2024. Accessed [insert date]. http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
Abbreviated full citation: OPTN/SRTR 2022 Annual Data Report. HHS/HRSA; 2024. Accessed [insert date]. http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
Chapter citation: [Authors]. OPTN/SRTR 2022 Annual Data Report: [chapter]. Accessed [insert date]. http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
Chapter citation for AJT e-supplement available at amjtransplant.org: [Authors]. OPTN/SRTR 2022 Annual Data Report: [chapter]. Am J Transplant. 2024;24([issue and suppl numbers]):[page range]. [doi]

Publications based on data in this report or supplied on request must include a citation and the following statement: The data and analyses reported in the OPTN/SRTR 2022 Annual Data Report have been supplied by the United Network for Organ Sharing and Hennepin Healthcare Research Institute under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the U.S. government.

This report is available at https://srtr.transplant.hrsa.gov. Individual chapters may be downloaded.

List of Figures

Figure HR 1: New adult candidates added to the heart transplant waiting list
Figure HR 2: All adult candidates on the heart transplant waiting list
Figure HR 3: Distribution of adults waiting for heart transplant by age
Figure HR 4: Distribution of adults waiting for heart transplant by sex
Figure HR 5: Distribution of adults waiting for heart transplant by race and ethnicity
Figure HR 6: Distribution of adults waiting for heart transplant by diagnosis
Figure HR 7: Distribution of adults waiting for heart transplant by waiting time
Figure HR 8: Distribution of adults waiting for heart transplant by former medical urgency groups through October 17, 2018
Figure HR 9: Distribution of adults waiting for heart transplant by new medical urgency groups, October 18, 2018, through 2022
Figure HR 10: Distribution of adults waiting for heart transplant by BMI
Figure HR 11: Distribution of adults waiting for heart transplant by blood type
Figure HR 12: Distribution of adults waiting for heart transplant by prior transplant status
Figure HR 13: Overall deceased donor heart transplant rates among adult waitlist candidates
Figure HR 14: Deceased donor heart transplant rates among adult waitlist candidates by age
Figure HR 15: Deceased donor heart transplant rates among adult waitlist candidates by race and ethnicity
Figure HR 16: Deceased donor heart transplant rates among adult waitlist candidates by diagnosis
Figure HR 17: Deceased donor heart transplant rates among adult waitlist candidates by blood type
Figure HR 18: Deceased donor heart transplant rates among adult waitlist candidates by sex
Figure HR 19: Deceased donor heart transplant rates among adult waitlist candidates by former medical urgency groups through October 17, 2018
Figure HR 20: Deceased donor heart transplant rates among adult waitlist candidates by new medical urgency groups, October 18, 2018, through 2022
Figure HR 21: Deceased donor heart transplant rates among adult waitlist candidates by height
Figure HR 22: Deceased donor heart transplant rates among adult waitlist candidates by metropolitan versus nonmetropolitan residence
Figure HR 23: Three-year outcomes for adults waiting for heart transplant, new listings in 2019
Figure HR 24: Percentage of adults who underwent deceased donor heart transplant within a given period of listing
Figure HR 25: Overall pretransplant mortality rates among adults waitlisted for heart transplant
Figure HR 26: Pretransplant mortality rates among adults waitlisted for heart transplant by age
Figure HR 27: Pretransplant mortality rates among adults waitlisted for heart transplant by race and ethnicity
Figure HR 28: Pretransplant mortality rates among adults waitlisted for heart transplant by sex
Figure HR 29: Pretransplant mortality rates among adults waitlisted for heart transplant by diagnosis
Figure HR 30: Pretransplant mortality rates among adults waitlisted for heart transplant by metropolitan versus nonmetropolitan residence
Figure HR 31: Pretransplant mortality rates among adults waitlisted for heart transplant by former medical urgency groups through October 17, 2018
Figure HR 32: Pretransplant mortality rates among adults waitlisted for heart transplant by new medical urgency groups, October 18, 2018, through 2022
Figure HR 33: Pretransplant mortality rates among adults waitlisted for heart transplant in 2022 by DSA
Figure HR 34: Deaths within 6 months after removal among adult heart waitlist candidates, overall
Figure HR 35: Deaths within 6 months after removal among adult heart waitlist candidates, by age
Figure HR 36: Deaths within 6 months after removal among adult heart waitlist candidates by race and ethnicity
Figure HR 37: Deaths within 6 months after removal among adult heart waitlist candidates, by sex
Figure HR 38: Deaths within 6 months after removal among adult heart waitlist candidates, by status at removal
Figure HR 39: Overall deceased heart donor count
Figure HR 40: Deceased heart donor count by age
Figure HR 41: Distribution of deceased heart donors by age
Figure HR 42: Distribution of deceased heart donors by sex
Figure HR 43: Distribution of deceased heart donors by race and ethnicity
Figure HR 44: Distribution of deceased heart donors by donor HCV status
Figure HR 45: Distribution of deceased heart donors by donor type
Figure HR 46: Cause of death among deceased heart donors
Figure HR 47: Overall percent of hearts recovered for transplant and not transplanted
Figure HR 48: Percent of hearts recovered for transplant and not transplanted by donor age
Figure HR 49: Percent of hearts recovered for transplant and not transplanted by donor sex
Figure HR 50: Percent of hearts recovered for transplant and not transplanted by donor race and ethnicity
Figure HR 51: Percent of hearts recovered for transplant and not transplanted by donor hypertension status
Figure HR 52: Percent of hearts recovered for transplant and not transplanted by donor BMI
Figure HR 53: Percent of hearts recovered for transplant and not transplanted by donor cause of death
Figure HR 54: Percent of hearts recovered for transplant and not transplanted, by donor risk of disease transmission
Figure HR 55: Overall adult heart transplants
Figure HR 56: Adult heart transplants by age
Figure HR 57: Adult heart transplants by sex
Figure HR 58: Adult heart transplants by race and ethnicity
Figure HR 59: Adult heart transplants by diagnosis
Figure HR 60: Adult heart transplants by medical urgency
Figure HR 61: Adult heart transplants by multiorgan transplant type
Figure HR 62: Induction agent use in adult heart transplant recipients
Figure HR 63: Immunosuppression regimen use in adult heart transplant recipients
Figure HR 64: Patient death among adult heart transplant recipients
Figure HR 65: Patient survival among adult heart transplant recipients, 2015-2017
Figure HR 66: Patient survival among adult heart transplant recipients, 2015-2017, by age
Figure HR 67: Patient survival among adult heart transplant recipients, 2015-2017, by race and ethnicity
Figure HR 68: Patient survival among adult heart transplant recipients, 2015-2017, by diagnosis group
Figure HR 69: Patient survival among adult heart transplant recipients, 2015-2017, by sex
Figure HR 70: Patient survival among adult heart transplant recipients, 2015-2017, by VAD status
Figure HR 71: Patient survival among adult heart transplant recipients, 2015-2017, by former medical urgency
Figure HR 72: Patient survival among adult heart transplant recipients, 2019-2020, by new medical urgency
Figure HR 73: Patient survival among adult heart transplant recipients, 2015-2017, by metropolitan versus nonmetropolitan recipient residence
Figure HR 74: Patient survival among adult heart transplant recipients, 2015-2017, by multiorgan transplant type
Figure HR 75: Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age
Figure HR 76: Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2011-2017
Figure HR 77: New pediatric candidates added to the heart transplant waiting list
Figure HR 78: All pediatric candidates on the heart transplant waiting list
Figure HR 79: Distribution of pediatric candidates waiting for heart transplant by age
Figure HR 80: Distribution of pediatric candidates waiting for heart transplant by race and ethnicity
Figure HR 81: Distribution of pediatric candidates waiting for heart transplant by diagnosis
Figure HR 82: Distribution of pediatric candidates waiting for heart transplant by sex
Figure HR 83: Distribution of pediatric candidates waiting for heart transplant by waiting time
Figure HR 84: Distribution of pediatric candidates waiting for heart transplant by medical urgency
Figure HR 85: Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2017-2019
Figure HR 86: Overall deceased donor heart transplant rates among pediatric waitlist candidates
Figure HR 87: Deceased donor heart transplant rates among pediatric waitlist candidates by age
Figure HR 88: Deceased donor heart transplant rates among pediatric waitlist candidates by race and ethnicity
Figure HR 89: Deceased donor heart transplant rates among pediatric waitlist candidates by metropolitan versus nonmetropolitan residence
Figure HR 90: Overall pretransplant mortality rates among pediatric candidates waitlisted for heart
Figure HR 91: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by age
Figure HR 92: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by race and ethnicity
Figure HR 93: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by diagnosis
Figure HR 94: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by medical urgency
Figure HR 95: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by metropolitan versus nonmetropolitan residence
Figure HR 96: Overall pediatric heart transplants
Figure HR 97: Pediatric heart transplants by recipient age
Figure HR 98: Pediatric heart transplants by sex
Figure HR 99: Pediatric heart transplants by race and ethnicity
Figure HR 100: Pediatric heart transplants by diagnosis
Figure HR 101: Pediatric heart transplants by medical urgency
Figure HR 102: Induction agent use in pediatric heart transplant recipients
Figure HR 103: Immunosuppression regimen use in pediatric heart transplant recipients
Figure HR 104: Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age
Figure HR 105: Incidence of PTLD among pediatric heart transplant recipients by recipient EBV status at transplant, 2011-2017
Figure HR 106: Patient death among pediatric heart transplant recipients
Figure HR 107: Overall patient survival among pediatric deceased donor heart transplant recipients, 2015-2017
Figure HR 108: Patient survival among pediatric deceased donor heart transplant recipients, 2015-2017, by recipient age
Figure HR 109: Patient survival among pediatric deceased donor heart transplant recipients, 2015-2017, by race and ethnicity
Figure HR 110: Patient survival among pediatric deceased donor heart transplant recipients, 2015-2017, by diagnosis
Figure HR 111: Patient survival among pediatric deceased donor heart transplant recipients, 2015-2017, by medical urgency

List of Tables

Table HR 1: Demographic characteristics of adults on the heart transplant waiting list on December 31, 2012, and December 31, 2022
Table HR 2: Clinical characteristics of adults on the heart transplant waiting list on December 31, 2012, and December 31, 2022
Table HR 3: Listing characteristics of adults on the heart transplant waiting list on December 31, 2012, and December 31, 2022
Table HR 4: Medical urgency statuses 1 and 2 of adults on the heart transplant waiting list by OPTN region during 2021 and 2022
Table HR 5: Heart transplant waitlist activity among adults
Table HR 6: Removal reason among adult heart transplant candidates
Table HR 7: Adult heart transplant recipients on life support before transplant
Table HR 8: Demographic characteristics of adult heart transplant recipients, 2012 and 2022
Table HR 9: Clinical characteristics of adult heart transplant recipients, 2012 and 2022
Table HR 10: Transplant characteristics of adult heart transplant recipients, 2012 and 2022
Table HR 11: Demographic characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2012, and December 31, 2022
Table HR 12: Clinical characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2012, and December 31, 2022
Table HR 13: Listing characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2012, and December 31, 2022
Table HR 14: Heart transplant waitlist activity among pediatric candidates
Table HR 15: Removal reason among pediatric heart transplant candidates
Table HR 16: Pediatric heart transplant recipients on life support before transplant
Table HR 17: Demographic characteristics of pediatric heart transplant recipients, 2012 and 2022
Table HR 18: Clinical characteristics of pediatric heart transplant recipients, 2012 and 2022
Table HR 19: Transplant characteristics of pediatric heart transplant recipients, 2012 and 2022

**New adult candidates added to the heart transplant waiting list.** A new adult candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Active and inactive patients are included.

Figure HR 1: New adult candidates added to the heart transplant waiting list. A new adult candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Active and inactive patients are included.

**All adult candidates on the heart transplant waiting list.** Adult candidates on the list at any time during the year. Candidates listed at more than one center are counted once per listing.

Figure HR 2: All adult candidates on the heart transplant waiting list. Adult candidates on the list at any time during the year. Candidates listed at more than one center are counted once per listing.

**Distribution of adults waiting for heart transplant by age.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

Figure HR 3: Distribution of adults waiting for heart transplant by age. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

**Distribution of adults waiting for heart transplant by sex.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure HR 4: Distribution of adults waiting for heart transplant by sex. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

**Distribution of adults waiting for heart transplant by race and ethnicity.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure HR 5: Distribution of adults waiting for heart transplant by race and ethnicity. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

**Distribution of adults waiting for heart transplant by diagnosis.** Candidates waiting for transplant at any time in the given year. Active and inactive patients are included. Candidates listed at more than one center are counted once per listing.

Figure HR 6: Distribution of adults waiting for heart transplant by diagnosis. Candidates waiting for transplant at any time in the given year. Active and inactive patients are included. Candidates listed at more than one center are counted once per listing.

**Distribution of adults waiting for heart transplant by waiting time.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive candidates are included.

Figure HR 7: Distribution of adults waiting for heart transplant by waiting time. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive candidates are included.

**Distribution of adults waiting for heart transplant by former medical urgency groups through October 17, 2018.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency for 2017 and earlier is determined at the earliest of transplant, death, removal, or December 31 of the year. For 2018 medical urgency statuses, statuses 1A, 1B, and 2 were determined at the earliest of transplant, death, or removal. For candidates who stayed active on the waiting list on or after October 18, 2018, and for candidates who were newly waitlisted on or after that date, their statuses are shown in Figure HR 9. Inactive statuses with new listings on or after October 18, 2018, are excluded here in Figure HR 8.

Figure HR 8: Distribution of adults waiting for heart transplant by former medical urgency groups through October 17, 2018. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency for 2017 and earlier is determined at the earliest of transplant, death, removal, or December 31 of the year. For 2018 medical urgency statuses, statuses 1A, 1B, and 2 were determined at the earliest of transplant, death, or removal. For candidates who stayed active on the waiting list on or after October 18, 2018, and for candidates who were newly waitlisted on or after that date, their statuses are shown in Figure HR 9. Inactive statuses with new listings on or after October 18, 2018, are excluded here in Figure HR 8.

**Distribution of adults waiting for heart transplant by new medical urgency groups, October 18, 2018, through 2022.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency is determined at the earliest of transplant, death, removal, or December 31 of the year. For 2018 medical urgency statuses, statuses 1-6 and inactive status contain new listings on or after October 18, 2018, or existing listings from before the policy change.

Figure HR 9: Distribution of adults waiting for heart transplant by new medical urgency groups, October 18, 2018, through 2022. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency is determined at the earliest of transplant, death, removal, or December 31 of the year. For 2018 medical urgency statuses, statuses 1-6 and inactive status contain new listings on or after October 18, 2018, or existing listings from before the policy change.

**Distribution of adults waiting for heart transplant by BMI.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included. BMI, body mass index.

Figure HR 10: Distribution of adults waiting for heart transplant by BMI. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included. BMI, body mass index.

**Distribution of adults waiting for heart transplant by blood type.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure HR 11: Distribution of adults waiting for heart transplant by blood type. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

**Distribution of adults waiting for heart transplant by prior transplant status.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure HR 12: Distribution of adults waiting for heart transplant by prior transplant status. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

**Overall deceased donor heart transplant rates among adult waitlist candidates.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 13: Overall deceased donor heart transplant rates among adult waitlist candidates. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Deceased donor heart transplant rates among adult waitlist candidates by age.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

Figure HR 14: Deceased donor heart transplant rates among adult waitlist candidates by age. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

**Deceased donor heart transplant rates among adult waitlist candidates by race and ethnicity.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure HR 15: Deceased donor heart transplant rates among adult waitlist candidates by race and ethnicity. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

**Deceased donor heart transplant rates among adult waitlist candidates by diagnosis.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 16: Deceased donor heart transplant rates among adult waitlist candidates by diagnosis. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Deceased donor heart transplant rates among adult waitlist candidates by blood type.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 17: Deceased donor heart transplant rates among adult waitlist candidates by blood type. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Deceased donor heart transplant rates among adult waitlist candidates by sex.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 18: Deceased donor heart transplant rates among adult waitlist candidates by sex. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Deceased donor heart transplant rates among adult waitlist candidates by former medical urgency groups through October 17, 2018.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency is determined at the later of listing date or January 1 of the given year. For new listings on or after October 18, 2018, and for candidates who were newly waitlisted on or after that date, their medical urgency statuses are shown in Figure HR 20. Inactive statuses with new listings on or after October 18, 2018, are excluded here in Figure HR 19.

Figure HR 19: Deceased donor heart transplant rates among adult waitlist candidates by former medical urgency groups through October 17, 2018. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency is determined at the later of listing date or January 1 of the given year. For new listings on or after October 18, 2018, and for candidates who were newly waitlisted on or after that date, their medical urgency statuses are shown in Figure HR 20. Inactive statuses with new listings on or after October 18, 2018, are excluded here in Figure HR 19.

**Deceased donor heart transplant rates among adult waitlist candidates by new medical urgency groups, October 18, 2018, through 2022.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency is determined at the later of listing date or January 1 of the given year. For 2018 medical urgency statuses, statuses 1-6 and inactive status contain new listings on or after October 18, 2018.

Figure HR 20: Deceased donor heart transplant rates among adult waitlist candidates by new medical urgency groups, October 18, 2018, through 2022. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency is determined at the later of listing date or January 1 of the given year. For 2018 medical urgency statuses, statuses 1-6 and inactive status contain new listings on or after October 18, 2018.

**Deceased donor heart transplant rates among adult waitlist candidates by height.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 21: Deceased donor heart transplant rates among adult waitlist candidates by height. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Deceased donor heart transplant rates among adult waitlist candidates by metropolitan versus nonmetropolitan residence.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate's permanent zip code.

Figure HR 22: Deceased donor heart transplant rates among adult waitlist candidates by metropolitan versus nonmetropolitan residence. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate’s permanent zip code.

**Three-year outcomes for adults waiting for heart transplant, new listings in 2019.** Candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.

Figure HR 23: Three-year outcomes for adults waiting for heart transplant, new listings in 2019. Candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.

**Percentage of adults who underwent deceased donor heart transplant within a given period of listing.** Candidates listed at more than one center are counted once per listing.

Figure HR 24: Percentage of adults who underwent deceased donor heart transplant within a given period of listing. Candidates listed at more than one center are counted once per listing.

**Overall pretransplant mortality rates among adults waitlisted for heart transplant.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure HR 25: Overall pretransplant mortality rates among adults waitlisted for heart transplant. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Pretransplant mortality rates among adults waitlisted for heart transplant by age.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

Figure HR 26: Pretransplant mortality rates among adults waitlisted for heart transplant by age. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

**Pretransplant mortality rates among adults waitlisted for heart transplant by race and ethnicity.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure HR 27: Pretransplant mortality rates among adults waitlisted for heart transplant by race and ethnicity. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

**Pretransplant mortality rates among adults waitlisted for heart transplant by sex.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure HR 28: Pretransplant mortality rates among adults waitlisted for heart transplant by sex. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Pretransplant mortality rates among adults waitlisted for heart transplant by diagnosis.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure HR 29: Pretransplant mortality rates among adults waitlisted for heart transplant by diagnosis. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Pretransplant mortality rates among adults waitlisted for heart transplant by metropolitan versus nonmetropolitan residence.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate's permanent zip code.

Figure HR 30: Pretransplant mortality rates among adults waitlisted for heart transplant by metropolitan versus nonmetropolitan residence. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate’s permanent zip code.

**Pretransplant mortality rates among adults waitlisted for heart transplant by former medical urgency groups through October 17, 2018.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date or January 1 of the given year. The October 2018 OPTN heart allocation policy update changed the status groups. For 2018 medical urgency statuses, new listings on or after October 18, 2018, are not shown in this figure.

Figure HR 31: Pretransplant mortality rates among adults waitlisted for heart transplant by former medical urgency groups through October 17, 2018. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date or January 1 of the given year. The October 2018 OPTN heart allocation policy update changed the status groups. For 2018 medical urgency statuses, new listings on or after October 18, 2018, are not shown in this figure.

**Pretransplant mortality rates among adults waitlisted for heart transplant by new medical urgency groups, October 18, 2018, through 2022.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date or January 1 of the given year. The October 2018 OPTN heart allocation policy update changed the status groups. For 2018 medical urgency statuses, statuses 1-6 and inactive status contain new listings on or after October 18, 2018.

Figure HR 32: Pretransplant mortality rates among adults waitlisted for heart transplant by new medical urgency groups, October 18, 2018, through 2022. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date or January 1 of the given year. The October 2018 OPTN heart allocation policy update changed the status groups. For 2018 medical urgency statuses, statuses 1-6 and inactive status contain new listings on or after October 18, 2018.

**Pretransplant mortality rates among adults waitlisted for heart transplant in 2022 by DSA.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. DSA, donation service area.

Figure HR 33: Pretransplant mortality rates among adults waitlisted for heart transplant in 2022 by DSA. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. DSA, donation service area.

**Deaths within 6 months after removal among adult heart waitlist candidates, overall.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure HR 34: Deaths within 6 months after removal among adult heart waitlist candidates, overall. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

**Deaths within 6 months after removal among adult heart waitlist candidates, by age.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. Age is determined at removal.

Figure HR 35: Deaths within 6 months after removal among adult heart waitlist candidates, by age. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. Age is determined at removal.

**Deaths within 6 months after removal among adult heart waitlist candidates by race and ethnicity.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. The Other race category is composed of Native American and Multiracial categories.

Figure HR 36: Deaths within 6 months after removal among adult heart waitlist candidates by race and ethnicity. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. The Other race category is composed of Native American and Multiracial categories.

**Deaths within 6 months after removal among adult heart waitlist candidates, by sex.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure HR 37: Deaths within 6 months after removal among adult heart waitlist candidates, by sex. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

**Deaths within 6 months after removal among adult heart waitlist candidates, by status at removal.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. The October 2018 OPTN heart allocation policy update changed the status groups. The statuses 1A, 1B, and 2 listed first are through October 17, 2018, the last day before the policy update; the adult statuses listed are for October 18, 2018, and onward. Medical urgency is determined at the earliest of transplant, death, removal, or December 31 of the year.

Figure HR 38: Deaths within 6 months after removal among adult heart waitlist candidates, by status at removal. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. The October 2018 OPTN heart allocation policy update changed the status groups. The statuses 1A, 1B, and 2 listed first are through October 17, 2018, the last day before the policy update; the adult statuses listed are for October 18, 2018, and onward. Medical urgency is determined at the earliest of transplant, death, removal, or December 31 of the year.

Figure HR 39: Overall deceased heart donor count. Count of deceased donors whose hearts were recovered for transplant.

Figure HR 40: Deceased heart donor count by age. Count of deceased donors whose hearts were recovered for transplant.

Figure HR 41: Distribution of deceased heart donors by age. Deceased donors whose hearts were recovered for transplant.

Figure HR 42: Distribution of deceased heart donors by sex. Deceased donors whose hearts were recovered for transplant.

**Distribution of deceased heart donors by race and ethnicity.** Deceased donors whose hearts were recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

Figure HR 43: Distribution of deceased heart donors by race and ethnicity. Deceased donors whose hearts were recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

**Distribution of deceased heart donors by donor HCV status.** Deceased donors whose hearts were recovered for transplant. Donor HCV status was based on an antibody test. HCV, hepatitis C virus.

Figure HR 44: Distribution of deceased heart donors by donor HCV status. Deceased donors whose hearts were recovered for transplant. Donor HCV status was based on an antibody test. HCV, hepatitis C virus.

**Distribution of deceased heart donors by donor type.** Deceased donors whose hearts were recovered for transplant. DBD, donation after brain death; DCD, donation after circulatory death.

Figure HR 45: Distribution of deceased heart donors by donor type. Deceased donors whose hearts were recovered for transplant. DBD, donation after brain death; DCD, donation after circulatory death.

**Cause of death among deceased heart donors.** Deceased donors with a heart recovered for the purposes of transplant. CVA, cerebrovascular accident.

Figure HR 46: Cause of death among deceased heart donors. Deceased donors with a heart recovered for the purposes of transplant. CVA, cerebrovascular accident.

**Overall percent of hearts recovered for transplant and not transplanted.** Percentages of hearts not transplanted out of all hearts recovered for transplant.

Figure HR 47: Overall percent of hearts recovered for transplant and not transplanted. Percentages of hearts not transplanted out of all hearts recovered for transplant.

**Percent of hearts recovered for transplant and not transplanted by donor age.** Percentages of hearts not transplanted out of all hearts recovered for transplant.

Figure HR 48: Percent of hearts recovered for transplant and not transplanted by donor age. Percentages of hearts not transplanted out of all hearts recovered for transplant.

**Percent of hearts recovered for transplant and not transplanted by donor sex.** Percentages of hearts not transplanted out of all hearts recovered for transplant.

Figure HR 49: Percent of hearts recovered for transplant and not transplanted by donor sex. Percentages of hearts not transplanted out of all hearts recovered for transplant.

**Percent of hearts recovered for transplant and not transplanted by donor race and ethnicity.** Percentages of hearts not transplanted out of all hearts recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

Figure HR 50: Percent of hearts recovered for transplant and not transplanted by donor race and ethnicity. Percentages of hearts not transplanted out of all hearts recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

**Percent of hearts recovered for transplant and not transplanted by donor hypertension status.** Percentages of hearts not transplanted out of all hearts recovered for transplant.

Figure HR 51: Percent of hearts recovered for transplant and not transplanted by donor hypertension status. Percentages of hearts not transplanted out of all hearts recovered for transplant.

**Percent of hearts recovered for transplant and not transplanted by donor BMI.** Percentages of hearts not transplanted out of all hearts recovered for transplant. BMI, body mass index.

Figure HR 52: Percent of hearts recovered for transplant and not transplanted by donor BMI. Percentages of hearts not transplanted out of all hearts recovered for transplant. BMI, body mass index.

**Percent of hearts recovered for transplant and not transplanted by donor cause of death.** Percentages of hearts not transplanted out of all hearts recovered for transplant. CVA, cerebrovascular accident.

Figure HR 53: Percent of hearts recovered for transplant and not transplanted by donor cause of death. Percentages of hearts not transplanted out of all hearts recovered for transplant. CVA, cerebrovascular accident.

**Percent of hearts recovered for transplant and not transplanted, by donor risk of disease transmission.** Percentages of hearts not transplanted out of all hearts recovered for transplant. "Increased risk" is defined by criteria from the US Public Health Service Guidelines for increased risk for HIV, hepatitis B, and hepatitis C transmission.

Figure HR 54: Percent of hearts recovered for transplant and not transplanted, by donor risk of disease transmission. Percentages of hearts not transplanted out of all hearts recovered for transplant. “Increased risk” is defined by criteria from the US Public Health Service Guidelines for increased risk for HIV, hepatitis B, and hepatitis C transmission.

Figure HR 55: Overall adult heart transplants. All adult heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 56: Adult heart transplants by age. All adult heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 57: Adult heart transplants by sex. All adult heart transplant recipients, including retransplant and multiorgan recipients.

**Adult heart transplants by race and ethnicity.** All adult heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 58: Adult heart transplants by race and ethnicity. All adult heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 59: Adult heart transplants by diagnosis. All adult heart transplant recipients, including retransplant and multiorgan recipients.

**Adult heart transplants by medical urgency.** All adult heart transplant recipients, including retransplant and multiorgan recipients. The October 2018 OPTN heart allocation policy update changed the status groups. The statuses 1A, 1B, and 2 listed first are through October 17, 2018, the last day before the policy update; the adult statuses listed are for October 18, 2018, and onward.

Figure HR 60: Adult heart transplants by medical urgency. All adult heart transplant recipients, including retransplant and multiorgan recipients. The October 2018 OPTN heart allocation policy update changed the status groups. The statuses 1A, 1B, and 2 listed first are through October 17, 2018, the last day before the policy update; the adult statuses listed are for October 18, 2018, and onward.

**Adult heart transplants by multiorgan transplant type.** All adult heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 61: Adult heart transplants by multiorgan transplant type. All adult heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 62: Induction agent use in adult heart transplant recipients. Immunosuppression at transplant reported to the OPTN.

**Immunosuppression regimen use in adult heart transplant recipients.** Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

Figure HR 63: Immunosuppression regimen use in adult heart transplant recipients. Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

**Patient death among adult heart transplant recipients.** All adult recipients of deceased donor hearts, including multiorgan transplant recipients.

Figure HR 64: Patient death among adult heart transplant recipients. All adult recipients of deceased donor hearts, including multiorgan transplant recipients.

**Patient survival among adult heart transplant recipients, 2015-2017.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 65: Patient survival among adult heart transplant recipients, 2015-2017. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2015-2017, by age.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 66: Patient survival among adult heart transplant recipients, 2015-2017, by age. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2015-2017, by race and ethnicity.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 67: Patient survival among adult heart transplant recipients, 2015-2017, by race and ethnicity. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2015-2017, by diagnosis group.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 68: Patient survival among adult heart transplant recipients, 2015-2017, by diagnosis group. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2015-2017, by sex.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 69: Patient survival among adult heart transplant recipients, 2015-2017, by sex. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2015-2017, by VAD status.** Patient survival estimated using unadjusted Kaplan-Meier methods. VAD status at time of transplant. VAD, ventricular assist device.

Figure HR 70: Patient survival among adult heart transplant recipients, 2015-2017, by VAD status. Patient survival estimated using unadjusted Kaplan-Meier methods. VAD status at time of transplant. VAD, ventricular assist device.

**Patient survival among adult heart transplant recipients, 2015-2017, by former medical urgency.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 71: Patient survival among adult heart transplant recipients, 2015-2017, by former medical urgency. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2019-2020, by new medical urgency.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 72: Patient survival among adult heart transplant recipients, 2019-2020, by new medical urgency. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2015-2017, by metropolitan versus nonmetropolitan recipient residence.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 73: Patient survival among adult heart transplant recipients, 2015-2017, by metropolitan versus nonmetropolitan recipient residence. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2015-2017, by multiorgan transplant type.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 74: Patient survival among adult heart transplant recipients, 2015-2017, by multiorgan transplant type. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age.** Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

Figure HR 75: Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age. Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

**Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2011-2017.** Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin's disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

Figure HR 76: Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2011-2017. Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin’s disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

**New pediatric candidates added to the heart transplant waiting list.** A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure HR 77: New pediatric candidates added to the heart transplant waiting list. A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

**All pediatric candidates on the heart transplant waiting list.** Pediatric candidates listed at any time during the year. Candidates listed at more than one center are counted once per listing.

Figure HR 78: All pediatric candidates on the heart transplant waiting list. Pediatric candidates listed at any time during the year. Candidates listed at more than one center are counted once per listing.

**Distribution of pediatric candidates waiting for heart transplant by age.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

Figure HR 79: Distribution of pediatric candidates waiting for heart transplant by age. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

**Distribution of pediatric candidates waiting for heart transplant by race and ethnicity.** Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included.

Figure HR 80: Distribution of pediatric candidates waiting for heart transplant by race and ethnicity. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included.

**Distribution of pediatric candidates waiting for heart transplant by diagnosis.** Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. CM, cardiomyopathy.

Figure HR 81: Distribution of pediatric candidates waiting for heart transplant by diagnosis. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. CM, cardiomyopathy.

**Distribution of pediatric candidates waiting for heart transplant by sex.** Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure HR 82: Distribution of pediatric candidates waiting for heart transplant by sex. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

**Distribution of pediatric candidates waiting for heart transplant by waiting time.** Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive candidates are included.

Figure HR 83: Distribution of pediatric candidates waiting for heart transplant by waiting time. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive candidates are included.

**Distribution of pediatric candidates waiting for heart transplant by medical urgency.** Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Medical urgency is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive patients are included.

Figure HR 84: Distribution of pediatric candidates waiting for heart transplant by medical urgency. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Medical urgency is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive patients are included.

**Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2017-2019.** Pediatric candidates who joined the waiting list in 2017-2019. Pediatric candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.

Figure HR 85: Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2017-2019. Pediatric candidates who joined the waiting list in 2017-2019. Pediatric candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.

**Overall deceased donor heart transplant rates among pediatric waitlist candidates.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 86: Overall deceased donor heart transplant rates among pediatric waitlist candidates. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Deceased donor heart transplant rates among pediatric waitlist candidates by age.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

Figure HR 87: Deceased donor heart transplant rates among pediatric waitlist candidates by age. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

**Deceased donor heart transplant rates among pediatric waitlist candidates by race and ethnicity.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure HR 88: Deceased donor heart transplant rates among pediatric waitlist candidates by race and ethnicity. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

**Deceased donor heart transplant rates among pediatric waitlist candidates by metropolitan versus nonmetropolitan residence.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 89: Deceased donor heart transplant rates among pediatric waitlist candidates by metropolitan versus nonmetropolitan residence. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Overall pretransplant mortality rates among pediatric candidates waitlisted for heart.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure HR 90: Overall pretransplant mortality rates among pediatric candidates waitlisted for heart. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by age.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

Figure HR 91: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by age. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

**Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by race and ethnicity.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure HR 92: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by race and ethnicity. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure HR 93: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by diagnosis. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. CM, cardiomyopathy.

**Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by medical urgency.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date or January 1 of the given year.

Figure HR 94: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by medical urgency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date or January 1 of the given year.

**Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by metropolitan versus nonmetropolitan residence.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate's permanent zip code.

Figure HR 95: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by metropolitan versus nonmetropolitan residence. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate’s permanent zip code.

**Overall pediatric heart transplants.** All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 96: Overall pediatric heart transplants. All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

**Pediatric heart transplants by recipient age.** All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 97: Pediatric heart transplants by recipient age. All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

**Pediatric heart transplants by sex.** All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 98: Pediatric heart transplants by sex. All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

**Pediatric heart transplants by race and ethnicity.** All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 99: Pediatric heart transplants by race and ethnicity. All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

**Pediatric heart transplants by diagnosis.** All pediatric heart transplant recipients, including retransplant and multiorgan recipients. CM, cardiomyopathy.

Figure HR 100: Pediatric heart transplants by diagnosis. All pediatric heart transplant recipients, including retransplant and multiorgan recipients. CM, cardiomyopathy.

**Pediatric heart transplants by medical urgency.** All pediatric heart transplant recipients, including retransplant and multiorgan recipients. The OPTN heart allocation policy changed the status groups in October 2018.

Figure HR 101: Pediatric heart transplants by medical urgency. All pediatric heart transplant recipients, including retransplant and multiorgan recipients. The OPTN heart allocation policy changed the status groups in October 2018.

Figure HR 102: Induction agent use in pediatric heart transplant recipients. Immunosuppression at transplant reported to the OPTN.

**Immunosuppression regimen use in pediatric heart transplant recipients.** Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

Figure HR 103: Immunosuppression regimen use in pediatric heart transplant recipients. Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

**Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age.** Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

Figure HR 104: Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age. Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

**Incidence of PTLD among pediatric heart transplant recipients by recipient EBV status at transplant, 2011-2017.** Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or on the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin's disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

Figure HR 105: Incidence of PTLD among pediatric heart transplant recipients by recipient EBV status at transplant, 2011-2017. Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or on the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin’s disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

**Patient death among pediatric heart transplant recipients.** All pediatric recipients of deceased donor hearts, including multiorgan transplant recipients. Estimates are unadjusted, computed using unadjusted Kaplan-Meier methods.

Figure HR 106: Patient death among pediatric heart transplant recipients. All pediatric recipients of deceased donor hearts, including multiorgan transplant recipients. Estimates are unadjusted, computed using unadjusted Kaplan-Meier methods.

**Overall patient survival among pediatric deceased donor heart transplant recipients, 2015-2017.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 107: Overall patient survival among pediatric deceased donor heart transplant recipients, 2015-2017. Recipient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among pediatric deceased donor heart transplant recipients, 2015-2017, by recipient age.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 108: Patient survival among pediatric deceased donor heart transplant recipients, 2015-2017, by recipient age. Recipient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among pediatric deceased donor heart transplant recipients, 2015-2017, by race and ethnicity.** Recipient survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

Figure HR 109: Patient survival among pediatric deceased donor heart transplant recipients, 2015-2017, by race and ethnicity. Recipient survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

**Patient survival among pediatric deceased donor heart transplant recipients, 2015-2017, by diagnosis.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 110: Patient survival among pediatric deceased donor heart transplant recipients, 2015-2017, by diagnosis. Recipient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among pediatric deceased donor heart transplant recipients, 2015-2017, by medical urgency.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 111: Patient survival among pediatric deceased donor heart transplant recipients, 2015-2017, by medical urgency. Recipient survival estimated using unadjusted Kaplan-Meier methods.