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Updated: May 14, 2026
Cardiac Loading using Passive Left Atrial Pressurization and Passive Afterload for Graft Assessment
Published on: August 2, 2024
Impact of long term left ventricular assist device therapy on donor allocation in cardiac transplantation
Nir Uriel1, Ulrich P Jorde, Sang Woo Pak
1Divisions of Cardiology, College of Physicians and Surgeons, Columbia University, NewYork, New York, USA. urielnir@gmail.com
Insights
The use of Left Ventricular Assist Devices (LVAD) as a bridge to transplant has increased significantly for heart failure patients. Most LVAD patients now receive transplants due to device complications, not within the initial priority window.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Left Ventricular Assist Devices (LVAD) are increasingly utilized for patients with advanced congestive heart failure (CHF).
- LVADs serve as a bridge to transplant (BTT), often granting patients high priority status (UNOS 1B or 1A).
Purpose of the Study:
- To evaluate the impact of organ allocation strategies in the era of continuous-flow LVADs.
- To analyze trends in heart transplantation for patients bridged with LVADs.
Main Methods:
- Retrospective chart review of adult heart transplant recipients from January 2001 to January 2011.
- Analysis of organ allocation status (UNOS 1A, 1B, 2) for both LVAD and non-device patients.
Main Results:
- The percentage of heart transplant patients bridged with LVADs rose from 19% in 2001 to 64% in 2010.
- A significant decline was observed in transplants occurring within the 30-day UNOS 1A period, with 84% of LVAD patients in 2011 requiring extended time due to device complications.
- Post-transplant survival showed no significant difference across UNOS priority groups (1B, 1A grace period, or device complication).
Conclusions:
- Increasing wait times for cardiac transplantation correlate with a higher utilization of LVADs for bridging.
- The majority of LVAD patients are now transplanted under conditions of device complication, highlighting evolving management strategies.
Background:
Left Ventricular Assist Devices (LVAD) are increasingly used as a bridge to transplant (BTT) for patients with advanced congestive heart failure (CHF) and are assigned United Network for Organ Sharing (UNOS) high priority status (1B or 1A).
Methods:
The purpose of our study was asses the effect of organ allocation in the era of continuous flow pumps. A retrospective chart review was performed of all patients transplanted between 1/2001-1/2011 at Columbia University Medical Center.
Results:
Seven hundred twenty six adult heart transplantations were performed. Two hundred seventy four BTT patients were implanted with LVAD; of which 227 patients were transplanted. Sixty three patients were transplanted as UNOS-1B, while 164 were transplanted as UNOS-1A (72%). Of these 164 patients, 65 were transplanted during their 30-day 1A period (43%) and 96 after upgrading to UNOS-1A for device complication (56%). For 452 non-device patients 139 (31%) were transplanted as UNOS-1A, 233 as UNOS-1B (52%), and 80 as UNOS-2 (17%). The percentage of patients bridged with LVAD increased from 19% in 2001 to 64% in 2010 while the number transplanted during their 30 day 1A grace period declined from 57% in 2005 to 16% in 2011; i.e. 84% of BTT patients in 2011 needed more than 30 days 1A time to be transplanted. Most LVAD patients are now transplanted while suffering device complication. There was no difference in post transplant survival between LVAD patients transplanted as UNOS 1B, 1A grace period or for a device complication
Conclusions:
As wait time for cardiac transplantation increased the percentage of patients being bridged to transplant with an LVAD has increased with the majority of them transplanted in the setting of device complication.
