Abstract Body (Do not enter title and authors here): Introduction: There have been increasing numbers of heart transplants performed yearly in the United States, but significant waitlist times and patient disparities remain. Multiple new transplant centers have started in all OPTN regions, facilitating new transplant listings and leading to broader population access to this life-saving therapy.

Research Question: Are there demographic differences in patient populations undergoing transplant at a newly established transplant center compared to existing centers?

Methods/Approach: This retrospective study utilized data from the Scientific Registry of Transplant Recipients (SRTR), which include data of all transplant candidates and recipients in the United States. Demographics were compared between the heart transplant centers opened from 2010 to 2023 (referred as “new centers”) at one year after opening and existing centers (continuously open since before 2010) in the same OPTN region in the same year, and cumulatively between all new and existing centers in the country since 2010. Demographic variables included age, gender, race, insurance status, and pre-transplant clinical condition were compared using t-tests and Chi-squared tests.

Results: Patients undergoing transplants at new centers were significantly older than those at existing centers, both by mean age (55.5 ± 12.3 vs. 53.3 ± 12.8; p < 0.001) and proportion ≥ 65 years old (26.3% vs. 20.5%; p < 0.001). Cumulatively, there was a higher proportion of Black patients at new centers (28.6% vs. 23.6%; p < 0.001). Patients at new centers were less likely to have private insurance (39.7% vs. 47.6%; p < 0.001) and more likely to be hospitalized in the ICU at time of transplant (59.4% vs. 42.0%; p < 0.001). Other than race, these differences were present both at one year after new center initiation and cumulatively in the entire study time period.

Conclusions: Patients undergoing heart transplant at new centers were found to be older, more likely to be Black, less likely to have private insurance, and more likely to be in the ICU at time of transplant compared to existing centers. These differences were present both in the first year after center initiation and cumulatively in the entire study time period, highlighting a persisting variation in population served by new centers. Transplant center initiation may expand access to cardiac transplant to patients who may otherwise have not been considered for this life saving therapy.