Impact of increased time at the highest urgency category on heart transplant outcomes for candidates with ventricular assist devices

Validating patient prioritization in the 2018 Revised United Network for Organ Sharing Heart Allocation System: A single‐center experience

“…First, this is a single‐center experience, which limits the generalizability of our findings. However, we found similarly high hazards of WL death/deterioration in patients with the highest acuity status as have been seen in other studies . Additionally, we only accounted for initial listing status in our primary analysis.…”

“…However, while status 1A patients were three times more likely to die than their status 1B counterparts, there were significant differences in WL mortality within the 1A group based on subtypes of necessary circulatory support. For example, in a large study of all HT listed patients from 2009 to 2011, Colvin et al showed that extracorporeal membrane oxygenation (ECMO) patients had a WL mortality rate of 41.6/100 PY, vs 18.1/100 PY in IABP patients, and 12.6/100 PY in patients with LVAD complications. In contrast, transplantation rates were 65.6/100 PY in the ECMO group, vs 62.9/100 PY in IABP patients, and 156.5/100 PY in patients with LVAD complications.…”

“…The number of status 1A candidates had increased more than fivefold since 2006, with more than 65% of adult HT being performed in these patients. 17 18 All of these were assigned a status 1A in the prior allocation system, but would now reclassify as tiers 1, 2, and 3, respectively, therefore improving organ access and increasing transplantation rates for these patients. 19 Extensive modeling using the Thoracic Simulation Allocation Model (TSAM) projected that the impact of the 2018 revision would be decreased WL mortality rates driven by increased transplant rates for higher tier patients.…”

“…However, we found similarly high hazards of WL death/deterioration in patients with the highest acuity status as have been seen in other studies. 18,24 Additionally, we only accounted for initial listing status in our primary analysis. However, only 38 (17.8%) such patients underwent a status upgrade and 10 (4.7%) a downgrade for medical improvement, so we do not believe that accounting for these changes would significantly affect our findings.…”

The future of cardiac transplantation

“…They simulated varying IA times for LVAD patients and looked at wait list mortality, transplant volume and post-transplant mortality. Surprisingly, allotting more IA time to LVAD patients did not significantly affect wait list mortality or post-transplant mortality (32). Stable LVAD patients have demonstrated remarkable outcomes with 2-year survival rates up to 70%.…”