The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.
Advanced Heart Failure and Transplantation Original Clinical Science|Articles in Press

Impact of 2018 Allocation System Change on Outcomes in Patients with Durable Left Ventricular Assist Device as Bridge to Transplantation: a UNOS Registry Analysis

Published:February 10, 2023DOI:



      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.


      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.


      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.


      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.


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