(646) Can Comparative Outcomes Following Solid Organ Transplantation Serve As a Launchpad for Value-Based Research Funding?

PurposeTransplant outcomes are well-described for individual organs, but comparative analyses are lacking. The present study sought to characterize trends in solid organ transplant outcomes and NIH research funding with the goal of informing outcomes-based resource allocation practices.MethodsUNOS was used to identify all kidney (KD; n=982,456), heart (HR; n=130,655), liver (LI; n=339,641) & lung (LU; n=69,673) transplant candidates (1987- 2022). Primary clinical outcomes were positive waitlist outcome (transplant or clinical improvement & post-transplant graft survival at 5- & 10-year post-transplant graft survival. Outcomes were studied by candidate age: 0-12 yr, 13-17 & >18. Research funding by organ was compiled from NIH reports (2017-2021).ResultsThe proportion of candidates experiencing positive waitlist outcomes and 5- & 10-year post-transplant graft survival are shown in the Table. For candidates 0-12yr & 13-17yr, waitlist outcomes were superior for KD, followed by LI, HR & LU (p<0.001 between all organs for both age groups). For candidates >18yr, positive waitlist outcomes were experienced by 75-81% for all organs. Five- & 10-year graft survival was overall similar (despite statistically significant differences) across all age groups for KD, HR & LI but was significantly worse for LU across all age groups, by approximately 50% at 5 years & by more than two-fold at 10 years. Similar trends were seen across all eras. Cumulative NIH funding was: $474,274,466 (KD); $167,457,066 (HR); $228,470,669 (LI); $220,787,146 (LU).ConclusionDifferences exist in pre- and post-transplant outcomes by age and organ. Kidney, heart & liver transplant recipients persistently experience superior outcomes than lung. Current research funding is not proportional to outcomes: kidney receives the most funding and heart the least. Knowledge of comparative outcomes and differences in research funding can help inform appropriate allocation of value-based funding to improve outcomes. Transplant outcomes are well-described for individual organs, but comparative analyses are lacking. The present study sought to characterize trends in solid organ transplant outcomes and NIH research funding with the goal of informing outcomes-based resource allocation practices. UNOS was used to identify all kidney (KD; n=982,456), heart (HR; n=130,655), liver (LI; n=339,641) & lung (LU; n=69,673) transplant candidates (1987- 2022). Primary clinical outcomes were positive waitlist outcome (transplant or clinical improvement & post-transplant graft survival at 5- & 10-year post-transplant graft survival. Outcomes were studied by candidate age: 0-12 yr, 13-17 & >18. Research funding by organ was compiled from NIH reports (2017-2021). The proportion of candidates experiencing positive waitlist outcomes and 5- & 10-year post-transplant graft survival are shown in the Table. For candidates 0-12yr & 13-17yr, waitlist outcomes were superior for KD, followed by LI, HR & LU (p<0.001 between all organs for both age groups). For candidates >18yr, positive waitlist outcomes were experienced by 75-81% for all organs. Five- & 10-year graft survival was overall similar (despite statistically significant differences) across all age groups for KD, HR & LI but was significantly worse for LU across all age groups, by approximately 50% at 5 years & by more than two-fold at 10 years. Similar trends were seen across all eras. Cumulative NIH funding was: $474,274,466 (KD); $167,457,066 (HR); $228,470,669 (LI); $220,787,146 (LU). Differences exist in pre- and post-transplant outcomes by age and organ. Kidney, heart & liver transplant recipients persistently experience superior outcomes than lung. Current research funding is not proportional to outcomes: kidney receives the most funding and heart the least. Knowledge of comparative outcomes and differences in research funding can help inform appropriate allocation of value-based funding to improve outcomes.