Six-Month Outcomes for Patients Bridged to Heart Transplantation with Veno-Arterial Extra-Corporeal Membrane Oxygenation before and after the Heart Allocation Policy Change

Abstract

The recent change in the UNOS heart allocation policy was intended to prioritize heart transplantation (HT) for the sickest patients based on hemodynamic (HD) criteria and the need for temporary mechanical circulatory support (tMCS). Patients meeting HD criteria and requiring veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) for circulatory support are designated as Status 1. Here, we report on 6-month outcomes and patient characteristics before and after the implementation of the heart allocation policy change in patients bridged to HT with VA-ECMO. 60 patients were identified in the UNOS database that were bridged to HT with VA-ECMO during a six-month period immediately before and after the policy change. Comparisons between patient characteristics in the pre (N=28) and post (N=32) policy-change cohorts are reported using standard statistical methods; survival analysis was performed using Cox proportional hazards modeling. Mean age was greater in the post-policy change group (46.1 ± 18.0 vs 34.6 ± 24.8 years, p=0.042). Median (interquartile range) time on the wait list was significantly shorter following the policy change [32.0 (14.0, 90.5) days vs 4.0 (2.0, 16.5) days, p<0.001]. There were no significant differences in mean donor age, ischemic time, renal function or pre-transplant hemodynamics. Additionally, there was no difference in 6-month survival between the groups (p=0.28). The heart allocation policy change significantly decreased wait-list times in patients bridged to HT with VA-ECMO without any observed difference in 6-month post-HT survival.