Supplementary Material

Figure S1

Figure S2

Figure S3

Figure S4

Table S1

Table S2

Figure S1

Figure S1: Total active waiting time spent at each priority status by the priority status at initial

listing for heart transplant. The percentage of the total active waiting time was computed for

each active status (1A, 1B and 2) for the study cohort, as divided by the priority status at initial

waiting list addition. For candidates initially listed at priority status 1A, 1B and 2, the majority of

active time was spent at that status (65.0%, 77.2% and 61.7%, respectively). For candidates

initially listed at priority status 7, the majority of time was spent at status 1B (61.3%).

Figure S2

Figure S2: Plot of the percentage of total heart transplant candidates added to the waiting list

with unacceptable HLA antigens (UA-HLA) entered from 1997 to 2013. The percentage of

candidates with UA-HLA was over 1% between years 2006 and 2013. The peak year was 2010

with 24.9% of heart transplant candidates listed with UA-HLA.

Figure S3

Figure S3: Change in calculated panel reactive antibody (CPRA) values in the study cohort

while on the waiting list. A: CPRA values were static (no change) in 2,447 (63.5%) candidates

and were dynamic (changed) in 1,408 candidates (36.5%). B: In candidates with dynamic

CPRA, 802 (57.0%) candidates displayed an increase in CPRA (positive change) from the first

to last CPRA value, and 606 (43.0%) candidates displayed a decrease in CPRA (negative

change) from the first to last CPRA value. Each vertical column represents an interval of 5%

CPRA.

Figure S4

Figure S4: Distribution of CPRA values for heart transplant candidates who did not receive a

transplant as compared to those that did receive a transplant. CPRA values in candidates that

did not receive a transplant (and either were still waiting, were removed or died on the waiting

list) were higher than in candidates that did receive a transplant (median CPRA 46% vs 26%, p

< 0.001).

Table S1: Characteristics of Patients Listed With and Without Unacceptable Antigens in

the UNOS Database

With UA

(n=3,978)

Without UA

(n=19,311)

Total

(n=23,389)

P value

Age (years) 52.0 52.7 52.6 0.007

Creatinine (mg/dL) 1.37 1.35 1.36 0.517

Female sex 1,486 (37.4%) 4,451 (22.9%) 5,937 (25.4%) <0.001

Previous HT 134 (3.4%) 407 (2.1%) 541 (2.3%) <0.001

Previous cardiac surgery <0.001

No 2,229 (56.0%) 1,188 (61.2%) 14,109 (60.3%)

Yes 1,732 (43.5%) 7,427 (38.3%) 9.159 (39.2%)

Unknown 17 (0.4%) 104 (0.5%) 121 (0.5%)

Ethnicity <0.001

Caucasian 2,556 (64.3%) 13,346 (68.8%) 15,902 (68.0%)

African American 1,092 (27.5%) 3,766 (19.4%) 4,858 (20.8%)

Latino 206 (5.2%) 1,532 (7.9%) 1,738 (7.4%)

Asian and Other 124 (3.1%) 767 (4.0%) 891 (3.8%)

UNOS region <0.001

Region 1 51 (1.3%) 1,029 (5.3%) 1,080 (4.6%)

Region 2 463 (11.6%) 2,627 (13.5%) 3,090 (13.2%)

Region 3 479 (12.0%) 2,309 (11.9%) 2,788 (11.9%)

Region 4 557 (14.0%) 1,998 (10.3%) 2,555 (10.9%)

Region 5 553 (13.9%) 2,705 (13.9%) 3,258 (13.9%)

Region 6 96 (2.4%) 500 (2.6%) 596 (2.6%)

Region 7 515 (13.0%) 1,839 (9.5%) 2,354 (10.1%)

Region 8 254 (6.4%) 1,107 (5.7%) 1,361 (5.8%)

Region 9 25 (0.6%) 1,616 (8.3%) 1,641 (7.0%)

Region 10 429 (10.8%) 1,530 (7.9%) 1,959 (8.4%)

Region 11 556 (14.0%) 2,151 (11.1%) 2,707 (11.6%)

MCS at transplant <0.001

None 2,852 (71.7%) 15,665 (80.7%) 18,517 (79.2%)

Left or right VAD 1,011 (25.4%) 3,181 (16.4%) 4,192 (17.9%)

BiVAD or TAH 115 (2.9%) 560 (2.9%) 675 (2.9%)

Initial priority status <0.001

1A 725 (18.2%) 4,170

(21.5%)

4,895 (20.9%)

1B 1,690 (42.5%) 7,403 (38.1%) 9,093 (38.9%)

2 1,462 (36.8%) 7,212 (37.2%) 8,674 (37.1%)

7 101 (2.5%) 626 (3.2%) 727 (3.1%)

UNOS = United Network for Organ Sharing; UA = unacceptable antigens; HT = heart transplant;

MCS = mechanical circulatory support; VAD = ventricular assist device; BiVAD = biventricular

assist device; TAH = total artificial heart.

Table S2: Post-Transplant Survival By CPRA Group

Group Hazard Ratio 95% Confidence

Interval

P value

Control (PRA 0%) reference reference reference

Group 1 (CPRA 0% to 20%) 1.00 0.83 - 1.20 0.997

Group 2 (CPRA 20.1% to 40%) 1.24 1.00 - 1.54 0.046

Group 3 (CPRA 40.1% to 60%) 1.39 1.09 - 1.77 0.008

Group 4 (CPRA 60.1% to 80%) 1.33 0.99 - 1.78 0.055

Group 5 (CPRA 80.1% to 100%) 1.32 0.96 - 1.81 0.092