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ng that persisted after risk adjustment (HR, 1.29; 95% CI, 1.07-1.55; P = .008). Substantial changes have occurred in adult heart transplant in the US after the policy change in October 2018. Wait list outcomes have improved, although posttransplant survival has decreased. These data confirm findings from earlier preliminary analyses and demonstrate that these trends have persisted to 1-year follow-up, underscoring the importance of continued reevaluation of the new heart allocation policy. Substantial changes have occurred in adult heart