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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. #link# 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 adu