Impact of New UNOS Allocation Criteria on Transplant Practices and Outcomes

J. Liu, B. Q. Yang, J. D. Schilling

Research output: Contribution to journalArticle

Abstract

PURPOSE: In October 2018, a new heart allocation policy was implemented. The new system was intended to decrease time on the wait list and prioritize allocation to the sickest patients. We examined the effects of this new policy on heart transplant recipients who underwent transplant one year prior to and one year after the policy change. METHODS: Adult patients who underwent heart transplant at our institution from October 2017 to September 2019 were identified and divided into two cohorts based on whether the date of transplant was before or after October 2018. Patient demographics, clinical data, and bridging strategy were recorded. Early outcomes studied included ischemic time, presence of severe PGD, need for renal replacement therapy or tracheostomy, duration of ICU stay, and total hospital stay. RESULTS: In total, 66 patients were identified. 38 patients were transplanted the year prior to the allocation change and 28 patients the year after. The most common listing status prior to the change was Status 1B (74%) and after was Status 2 (54%). After the allocation change, there was a decrease in average wait-time to transplant (313 days vs. 53 days, p=.04). In addition, patients were more likely to be inpatient prior to their transplant (11% vs. 68%, p<.01), were more likely to be bridged with an intra-aortic balloon pump (2.6% vs. 46%, p<.01), and less likely to be supported with a durable LVAD (83% vs. 18%, p<.01). Other than an increase in total ischemic time after the change, there were no significant differences in early post-transplant outcomes. CONCLUSION: Implementation of the new allocation system resulted in dramatic changes in the bridging strategy utilized at our institution. The number of patients supported with durable LVADs prior to transplant was substantially decreased and the use of temporary mechanical support increased following the change. Early post-transplant outcomes appear similar. Further investigation is needed to assess the long-term impact of the allocation change.

Original languageEnglish
Pages (from-to)S175-S176
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number4
DOIs
StatePublished - Apr 1 2020

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