Changes in Wait List Mortality, Transplantation Rates and Early Post-Transplant Outcomes in LVAD BTT with New Heart Transplant Allocation Score. A UNOS Database Analysis

Abstract

PurposeTo evaluate the effect of the new heart transplant allocation system on LVAD supported patients listed as bridge to transplantation (BTT).MethodsAdult patients, who were listed for heart transplant between October 1,2016 and September 30, 2019, and were supported with an LVAD, enrolled in the UNOS database were enrolled in this study. Patients were classified according in the old or new system if they were listed or transplanted before or after October 18, 2018.ResultsA total of 2184 LVAD patients were listed for transplant. Of these, 1229 were classified in the old and 955 in the new system. The cumulative incidence of death or removal from the transplant list due to worsening clinical status, 1 year after listing, was lower in the new system (5% vs. 9%, p<0.001). Patients listed in the new system had a lower frequency of transplantation within 1 year of listing (52% vs. 60%, p=0.004) (Figure 1). A total of 1086 and 853 patients were transplanted in the old and new systems, respectively. Patients who were transplanted in the new system were more likely to receive a Hep C (+) donor heart and had a longer ischemic time. The 6 months post-transplant survival was 93.2% and 91.5% for the old and new systems, respectively (p=0.18).ConclusionWith the implementation of the new HT allocation system, LVAD-BTT patients have a lower frequency of transplantation and similar short-term post-transplant survival. LVAD-BTT patients are more likely to receive Hep C (+) donor hearts. To evaluate the effect of the new heart transplant allocation system on LVAD supported patients listed as bridge to transplantation (BTT). Adult patients, who were listed for heart transplant between October 1,2016 and September 30, 2019, and were supported with an LVAD, enrolled in the UNOS database were enrolled in this study. Patients were classified according in the old or new system if they were listed or transplanted before or after October 18, 2018. A total of 2184 LVAD patients were listed for transplant. Of these, 1229 were classified in the old and 955 in the new system. The cumulative incidence of death or removal from the transplant list due to worsening clinical status, 1 year after listing, was lower in the new system (5% vs. 9%, p<0.001). Patients listed in the new system had a lower frequency of transplantation within 1 year of listing (52% vs. 60%, p=0.004) (Figure 1). A total of 1086 and 853 patients were transplanted in the old and new systems, respectively. Patients who were transplanted in the new system were more likely to receive a Hep C (+) donor heart and had a longer ischemic time. The 6 months post-transplant survival was 93.2% and 91.5% for the old and new systems, respectively (p=0.18). With the implementation of the new HT allocation system, LVAD-BTT patients have a lower frequency of transplantation and similar short-term post-transplant survival. LVAD-BTT patients are more likely to receive Hep C (+) donor hearts.