Background
This study compared outcomes of patients waitlisted for orthotopic heart transplantation
with durable left ventricular assist devices (LVAD) before and after the October 18,
2018 heart allocation policy change.
Methods
The United Network of Organ Sharing database was queried to identify 2 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 outcomes were 2-year survival from the time of initial waitlisting,
as well as 2-year post-transplant survival. Secondary outcomes included incidence
of transplantation from the waitlist and de-listing due to either death or clinical
deterioration.
Results
A total of 2,512 candidates were waitlisted, 1,253 within the OPE and 1,259 within
the NPE. Candidates under both policies had similar 2-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.
Conclusions
The 2018 heart allocation policy has conferred no significant impact on overall survival
from the time of initial waitlisting among durable LVAD-supported candidates. Similarly,
the 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
Published online: February 10, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
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
© 2023 International Society for Heart and Lung Transplantation. All rights reserved.
