Heart Transplant Outcomes for Patients with Left Ventricular Assist Devices (LVAD) Before and after the 2018 Revision of the United Network for Organ Sharing (UNOS) Adult Heart Allocation System

J. Pizula¹, K. Yang¹, J. Li¹, S. Shah¹, G. Liu¹, A. Lee¹, P. Banankhah¹, J. Nattiv¹, D. Miklin¹, P. Genyk¹, P. Kingsford¹, K. Pandya¹, R. Joeseph¹, M. Fong¹, G. Luanda¹, A. Kiankhooy¹, S. Hashmi¹, S. Nuno¹, A. Wolfson², A. Salimbangon³, R. Chand⁴, D. Vucicevic⁵, L. Corey⁶, E. Depasquale¹, A. Vaidya¹

¹Cardiology, LAC-USC, Los Angeles, CA, ²University of Arizona Sarver Heart Center, Tuscon, AZ, ³UCLA Medical Center, Los Angeles, CA, ⁴Harbor-UCLA Medical Center, Los Angeles, CA, ⁵Newark Beth-Israel Medical Center, Newark, NJ, ⁶The Queen's Medical Center, Honolulu, HI

Meeting: 2020 American Transplant Congress

Abstract number: C-287

Keywords: Allocation, Heart/lung transplantation, Survival

Session Information

Session Name: Poster Session C: Heart and VADs: All Topics

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: In October of 2018 UNOS chaged their adult heart allocation criteria to address disparity in waiting list survival. The implications of this policy change on patients with left ventricular assist devices is unknown.

*Methods: 577 LVAD patients were identified from the UNOS registry and grouped based on initial listing 6 months prior to (n= 408) and 6 months post (n=169) the policy change. Patient characteristics and transplant survival were assessed, and a cox multivariate proportional hazards regression analysis was preformed (adjusting for age, sex, diabetes, ethnicity, ischemic time, days waiting).

*Results: During the study period, 408 and 169 heart transplants occurred before and after UNOS policy change. Between groups there was no difference in age, gender, ethnicity, smoking, diabetes, creatinine, hemodynamics, IABP or ventilator support. Post policy change, LVAD patients had shorter waiting times with median 18 (IQR 8-52) vs 65 days (IQR 24.5-125) (p<0.001). There was significantly lower post-transplant survival in LVAD patients post policy change [HR 5.63 (2.2-14.5), p= < 0.001].

*Conclusions: Post UNOS policy change LVAD patients had lower overall post-transplant survival with the majority of these patients transplanted at statuses 1-3, despite shorter waiting time and similar baseline characteristics. Further study is warranted to understand the longterm implications of this policy change in this patient population.

To cite this abstract in AMA style:

Pizula J, Yang K, Li J, Shah S, Liu G, Lee A, Banankhah P, Nattiv J, Miklin D, Genyk P, Kingsford P, Pandya K, Joeseph R, Fong M, Luanda G, Kiankhooy A, Hashmi S, Nuno S, Wolfson A, Salimbangon A, Chand R, Vucicevic D, Corey L, Depasquale E, Vaidya A. Heart Transplant Outcomes for Patients with Left Ventricular Assist Devices (LVAD) Before and after the 2018 Revision of the United Network for Organ Sharing (UNOS) Adult Heart Allocation System [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/heart-transplant-outcomes-for-patients-with-left-ventricular-assist-devices-lvad-before-and-after-the-2018-revision-of-the-united-network-for-organ-sharing-unos-adult-heart-allocation-system/. Accessed November 22, 2024.

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