Investigating the 6-Month Effects of the UNOS Allocation System Changes on the Post Transplant Outcomes in Patients with Hypertrophic Cardiomyopathy

P. Banankhah¹, C. Lum², A. Salimbangon³, G. Liu¹, A. Wolfson⁴, E. DePasquale¹, R. Chand⁵, P. Genyk¹, P. Kingsford¹, J. Li¹, D. Vucicevic⁶, A. Vaidya¹, K. Pandya¹, J. Rahman¹, M. Fong¹, L. Grazette¹, J. Nattiv¹, S. Hashmi¹, S. Nuno¹, J. Pizula¹, A. Lee¹, K. Yang¹, S. Shah¹

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

Meeting: 2020 American Transplant Congress

Abstract number: C-288

Keywords: Allocation, Heart transplant patients

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: Hypertrophic cardiomyopathy (HCM) has a broad spectrum of presentations. However, the prognosis is poor in patients presenting with significant chamber remodeling, and they often require mechanical support before transplantation. In this study, we sought to investigate if the changes in the UNOS allocations system have improved the 6 month survival in patients with HCM.

*Methods: We identified 59 patients with HCM in the UNOS database who underwent heart transplant during a 6-month period immediately before and after the policy change. Our data included 43 pre and 16 post policy change patients. We used standard statistical methods to compare the patient characteristics in both groups. Survival analysis was performed using Cox proportional hazards modeling.

*Results: The recipient age, donor age, gender, ethnicity, diabetes status, and ischemic times were not significantly different between the two groups. The waitlist (WL) statuses of pre patients were 1A (n=22), 1B (n=11), 2 (n=10) while the WL statuses of the post patients were 1 (n=2), 2 (n=7), 3 (n=1), 4 (n=6). With the new allocation system, patients with HCM spent more total days on the WL (43 vs. 24.5 days, p=0.01). The use of IABP was significantly greater following the policy change (31% vs 5%, p<0.01). There was a trend toward worse survival outcomes post-transplant after the policy changes (p=0.06).

*Conclusions: Although patients with HCM on the transplant list had similar baseline characteristics pre and post changes in the UNOS organ allocation policy, HCM patients in the new allocation system were more likely to receive IABP support, and they had longer WL times. There was also a trend toward worse overall post-transplant survival.

To cite this abstract in AMA style:

Banankhah P, Lum C, Salimbangon A, Liu G, Wolfson A, DePasquale E, Chand R, Genyk P, Kingsford P, Li J, Vucicevic D, Vaidya A, Pandya K, Rahman J, Fong M, Grazette L, Nattiv J, Hashmi S, Nuno S, Pizula J, Lee A, Yang K, Shah S. Investigating the 6-Month Effects of the UNOS Allocation System Changes on the Post Transplant Outcomes in Patients with Hypertrophic Cardiomyopathy [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/investigating-the-6-month-effects-of-the-unos-allocation-system-changes-on-the-post-transplant-outcomes-in-patients-with-hypertrophic-cardiomyopathy/. Accessed November 22, 2024.

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