Utilization of Mechanical Circulatory Support Devices and Impact on Outcomes in the New Heart Allocation System: An Analysis of the UNOS Registry
1Duke University Medical Center, Durham, NC, 2Columbia University Irving Medical Center, New York City, NY, 3Columbia University Irving Medical Center, New York, NY
Meeting: 2020 American Transplant Congress
Abstract number: 296
Keywords: Allocation, Post-operative complications, Ventricular assist devices
Session Information
Date: Saturday, May 30, 2020
Session Name: Heart Transplantation: Allocation, Allocation, Allocation
Session Time: 3:15pm-4:45pm
Presentation Time: 4:03pm-4:15pm
Location: Virtual
*Purpose: In October 2018, a new heart transplantation allocation system was put into effect with the intent of better stratifying the most medically urgent candidates, including those with cardiogenic shock requiring percutaneous support, ECMO, and surgical support devices. We hypothesized that MCS utilization increased nationwide as a result of the new allocation system.
*Methods: The UNOS database were queried to identify patients who were listed for heart transplant on or after January 2017. Patients were categorized into: 1) old allocation (listed and removed before 10/18/2018) and 2) new allocation (listed on or after 10/18/2018) groups. Patients who crossed over from old to new allocation were excluded from the analysis. Mechanical circulatory device utilization and post-transplant graft survival were compared in the two eras.
*Results: 4663 patients were waitlisted during the old allocation compared to 1759 waitlisted patients in the new allocation system. There was a significant increase in the utilization of intra-aortic balloon pump (IABP) (6.1% to 9.7%, p<0.001) at transplant listing in the new allocation system, however ECMO (2.5% to 2.6%, p=0.833) and LVAD/RVAD/BiVAD/TAH (30.1% to 30.6%, p=0.731) use at listing were unchanged (Figure). At the time of heart transplant, there was a significantly higher utilization of IABP (9.4% to 32.7%) and ECMO (1.2% to 7.7%) accompanied by a lower utilization of LVAD/RVAD/BiVAD/TAH (40.5% to 30.0%) (all p<0.05). Post-transplant graft survival at 90 days was significantly lower in the new allocation compared to old (94.6% vs 84.8%, log-rank p<0.001). 90-day post-transplant survival was highest in patients bridging with IABP, compared to ECMO and LVAD/RVAD/BiVAD/TAH (93.5%, 68.2%, 78.6%, log rank p=0.002),
*Conclusions: There has been a significant increase in utilization of acute circulatory support devices nationwide as bridge to heart transplantation. Early post-transplant graft survival is significantly better for patients bridging with IABP support compared to ECMO or other surgical support devices.
To cite this abstract in AMA style:
Truby LK, Farr M, DeFilippis EM, Takeda K, Topkara VK. Utilization of Mechanical Circulatory Support Devices and Impact on Outcomes in the New Heart Allocation System: An Analysis of the UNOS Registry [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/utilization-of-mechanical-circulatory-support-devices-and-impact-on-outcomes-in-the-new-heart-allocation-system-an-analysis-of-the-unos-registry/. Accessed November 25, 2020.« Back to 2020 American Transplant Congress