Does the New Heart Transplantation Allocation System Improve Access to Transplantation for Restrictive and Hypertrophic Cardiomyopathy Patients? A UNOS Database Analysis
1Cardiology, Spectrum Health, Grand Rapids, MI, 2DeVos Cardiovascular Research Program, Spectrum Health, Grand Rapids, MI, 3Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI
Meeting: 2020 American Transplant Congress
Abstract number: 295
Keywords: Allocation, Heart transplant patients, Survival, Waiting lists
Session Information
Session Name: Heart Transplantation: Allocation, Allocation, Allocation
Session Type: Oral Abstract Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 3:51pm-4:03pm
Location: Virtual
*Purpose: Historically, patients with end-stage restrictive (RCM) and hypertrophic cardiomyopathy (HCM), experienced longer wait times and increased waitlist mortality while awaiting a heart transplant (HT) when compared to patients with end-stage dilated cardiomyopathies. On October 18th,2018, a new HT allocation system was implemented in the US. We sought to determine the impact of the new HT allocation system on end-stage RCM and HCM patients.
*Methods: Adult patients with the diagnosis of RCM (Amyloidosis, sarcoidosis, idiopathic RCM) and HCM, who were listed for HT between Nov 2017 and June 2019 were identified from the UNOS database. Patients listed for re-transplantation or multiorgan transplant were excluded. Patients who met criteria were stratified in 2 groups: old system (Nov 2017 – Oct 18th, 2018) and new system (Oct 18th, 2018 – June 2019). Clinical recipient and donor characteristics, waiting time on HT list, and 30 days post-transplant mortality were compared between groups.
*Results: A total of 582 patients were listed for HT with the diagnosis of RCM and HCM during the study period. Of these, 191 patients were transplanted in the old system and 133 with the new system. The waiting time prior to HT was significantly shorter with the new system, 52 days (8-146) vs. 65 days (27-162), (p=0.02). The ischemic time was significantly longer with the new system (3.3 ± 0.8 hrs. vs. 2.9 ± 1 hrs., p<0.001). Patients who received HT under the new system had a significantly higher use of intra-aortic balloon pump (IABP) at the time of transplantation (25.6% vs. 9.4%, p<0.001). There use of ECMO prior to HT was more frequent under the new system but did not achieve statistical significance (6% vs. 2.1%, p=0.08). Of the patients who received HT on the new system, the distribution of status at the time of HT was 8%, 52%, 16%, 22.5% and 1.5% for Status 1, 2, 3, 4 and 5 respectively. The 30 days post-transplant mortality was not different between old and new systems (p=0.7).
*Conclusions: With the implementation of the new HT allocation system, patients with end stage RCM and HCM have a decreased waiting time for HT, increased use of IABP at transplantation and longer ischemic times. Short term post-transplant survival was not impacted.
To cite this abstract in AMA style:
Loyaga-Rendon RY, Fermin DR, Jani M, Grayburn RL, Lee S, Dickinson MG, Gonzalez M, Shrestha NK, Boeve T, Jovinge S, Leacche M. Does the New Heart Transplantation Allocation System Improve Access to Transplantation for Restrictive and Hypertrophic Cardiomyopathy Patients? A UNOS Database Analysis [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/does-the-new-heart-transplantation-allocation-system-improve-access-to-transplantation-for-restrictive-and-hypertrophic-cardiomyopathy-patients-a-unos-database-analysis/. Accessed May 11, 2025.« Back to 2020 American Transplant Congress