Abstract 15264: Impact of 2018 Change in UNOS Heart Transplant Policy on Wait List Outcomes

Abstract

Introduction: In October 2018, the updated Heart transplant (HT) policy by United network of Organ Sharing (UNOS) gave priority to critically ill heart failure patients. It has made significant improvement in long term survival of ECMO bridged HT recipients. However, there are limited reports on wait list mortality following change in this policy. Hypothesis: Review of waitlist mortality following 2018 change in guideline Methods: This is a retrospective cohort study including all adult heart failure patients listed for HT alone between 2015 and 2022 in the UNOS data. Cohort was stratified on the basis of year of listing, those who listed between 2015 & 2018 and those who listed between 2019 & 2022. The categorical and continuous variables were compared using chi2 and Kruskal Wallis test, respectively. Time to death analysis between both the group was evaluated using Kaplan Meier curve and log rank test. Results: Total 33,908 patients were included, of them 16,281 were listed between 2015 & 2018 and remaining 17,627 were listed between 2019 & 2022. The rate of HT did not change between both the time period (10,660 (65.5%) & 11,660 (66.1%), p=0.19)), respectively. There was no difference in age, gender and BMI between both the groups. The use of Intra-aortic balloon pump, ventilator, Inotropes and other parameters indicating severity of illness were frequently noted among patients listed between 2019 & 2022. The overall wait list mortality has reduced from 1250/16,281(7.7%) to 764/17,627 (4.0%) during later time period, p<0.001 (Figure 1). Similarly, patients’ dropouts due to illness severity has reduced from 1321/16821 (8.1%) to 764/17,627 (4.3%), p<0.001, respectively. There is significant reduction in disease etiology specific mortality following 2018 change. Conclusions: The change in HT policy in 2018 has significantly reduced the wait list mortality and dropouts during study periods. In addition, sicker patients were listed for transplant following 2018 change.