ABSTRACT
Purpose
This study compared outcomes of patients waitlisted for orthotopic heart transplantation
(OHT) with durable left ventricular assist devices (LVAD) before and after the 10/18/2018
heart allocation policy change.
Methods
The United Network of Organ Sharing database was queried to identify two cohorts of
adult candidates with durable LVAD listed within seasonally-matched, equal-length
periods before (old policy era [OPE]) and after the policy change (new policy era
[NPE]).The primary outcome was two-year from time of initial waitlisting. Secondary
outcomes included incidence of transplantation from waitlist, de-listing due to death
and/or clinical deterioration, as well as post-transplant survival.
Results
2,512 candidates waitlisted, 1,253 within the OPE and 1,259 within the NPE. Candidates
under both policies had similar two-year survival after waitlisting, as well as a
similar cumulative incidence of transplantation and de-listing due to death and/or
clinical deterioration. A total of 2,560 patients were transplanted within the study
period, 1,418 OPE and 1,142 within the NPE. Two-year post-transplant survival was
similar between policy eras, however, the NPE was associated with a higher incidence
of post-transplant stroke, renal failure requiring dialysis, and a longer hospital
length of stay.
Conclusion
The 2018 heart allocation policy has conferred no significant impact on overall survival
from time of initial waitlisting among durable LVAD-supported candidates. Similarly,
cumulative incidence of transplantation and waitlist mortality have also been largely
unchanged. For those undergoing transplantation, a higher degree of post-transplant
morbidity was observed, though survival was not impacted.
Keywords
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Article info
Publication history
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of Interest: none
Funding: none
Institutional Review Board: This report was approved by the Institutional Review Board at the University of Pittsburgh (MOD18120143-003, approved 3/9/2020)
Presentation: This abstract was presented as an oral presentation at the International Society of Heart and Lung Transplantation 2022 annual meeting.
Identification
Copyright
© Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation.
