Korean J Transplant.  2023 Nov;37(Suppl 1):S298. 10.4285/ATW2023.F-9091.

The impact of regional allocation policy on heart transplantation outcomes in Korea: 2010–2022

• Kim KH
• Oh BH

• KMID: 2551927
• DOI: http://doi.org/10.4285/ATW2023.F-9091

Abstract

Background
In Korea, a regional prioritization system for heart transplantation was implemented in 2018. Given Koreas compact geographic size, we assessed the relevance of geographic distance versus patient severity on heart transplantation outcomes.
Methods
We retrospectively reviewed 1,740 heart transplant recipients between 2010 and 2022, stratified into three regions: area 1 (n=1,527), area 2 (n=16), and area 3 (n=197). The focus was on wait times, patient severity at the time of transplantation, and posttransplant survival rates.
Results
Area 1, despite housing the majority of transplant centers, had patients enduring prolonged waiting times (mean±standard deviation [SD], 219±515 days) compared to area 2 (mean±SD, 102±140 days) and area 3 (mean±SD, 140±341 days). Area 3 observed an increase in transplant centers, even with traditionally fewer facilities. Area 2 demonstrated lowered survival rates at all time points, with 1-month survival at 75% and 1-year survival at 62.5%. Intriguingly, cross-regional transplants, termed mismatch, showed enhanced survival rates (87.6%) when juxtaposed with within-region transplants (82.7%).
Conclusions
The findings indicate that in a geographically compact country like Korea, the distance to a transplant center might not be as critical as the severity of the patient’s condition. Despite the regional allocation intent, patients in transplant-dense regions experienced longer wait times. Prioritizing transplantation based on patient severity, rather than geographic proximity, could be a more effective approach for better patient outcomes.