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Published on: July 18, 2014
Continuous flow left ventricular assist device technology has influenced wait times and affected donor allocation in
Sharven Taghavi1, Senthil N Jayarajan1, Eugene Komaroff2
1Department of Surgery, Temple University School of Medicine, Philadelphia, Pa.
Insights
Continuous flow left ventricular assist devices (cfLVADs) increase waitlist survival for heart transplant candidates. Despite less favorable recipient profiles, cfLVAD patients achieve higher UNOS status and better outcomes while awaiting transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Continuous flow left ventricular assist devices (cfLVADs) are increasingly used as a bridge to heart transplantation.
- Patients with cfLVADs are prioritized under United Network for Organ Sharing (UNOS) status 1A or 1B.
- Understanding the impact of cfLVADs on organ allocation and waitlist dynamics is crucial.
Purpose of the Study:
- To investigate the influence of cfLVADs on heart transplant waitlist times.
- To analyze organ allocation patterns for patients bridged with cfLVADs.
- To compare outcomes of cfLVAD patients with those receiving pulsatile flow LVADs (pLVADs) and non-LVAD patients.
Main Methods:
- Utilized the United Network for Organ Sharing database from 2005 to 2012.
- Compared cohorts of patients with cfLVADs, pLVADs, and no LVAD.
- Analyzed waitlist times, UNOS status duration, waitlist survival, and donor/recipient characteristics.
Main Results:
- cfLVAD patients experienced significantly longer total waitlist times (259.6 days) compared to pLVAD (134.6 days) and non-LVAD (121.7 days) groups.
- The cfLVAD group spent more time in UNOS status 1A (44.7 days) than other groups.
- Median waitlist survival was superior for cfLVAD recipients (1234.0 days) versus pLVAD (441.0 days) and non-LVAD (471.0 days) groups.
- cfLVAD recipients were older, had higher BMI, and more comorbidities; they received organs from older, male donors with higher BMI.
- Post-transplant survival did not differ significantly across the three groups.
Conclusions:
- Despite being older and having less favorable recipient profiles, cfLVAD patients demonstrate improved waitlist survival.
- Extended time in higher UNOS status for cfLVAD patients may facilitate access to preferred donor hearts.
- These findings suggest cfLVADs can optimize organ allocation and potentially improve outcomes for heart transplant candidates.
Objective:
Bridge to transplantation patients with continuous flow left ventricular assist devices (cfLVADs) are assigned United Network for Organ Sharing status 1A or 1B priority while awaiting orthotopic heart transplantation. We investigated the influence of cfLVAD on the waitlist times and organ allocation.
Methods:
The United Network for Organ Sharing database was examined from 2005 to 2012 for patients with cfLVAD and pulsatile flow LVAD (pLVAD). These 2 cohorts were compared with patients who did not receive LVAD.
Results:
Of 16,476 total orthotopic heart transplantations, 3270 (19.8%) were performed on patients with an LVAD as a bridge to transplantation. The cfLVAD group had the longest total waitlist time (259.6 days) compared with the pLVAD (134.6 days) and non-LVAD (121.7 days) groups (P < .001). The cfLVAD group spent more time in status 1A (44.7 days) than did the pLVAD (32.1 days) and non-LVAD (16.4 days) cohorts (P < .001). The median waitlist survival was better for the cfLVAD group (1234.0 days) than in the pLVAD (441.0 days) and non-LVAD (471.0 days) groups (P < .001). The cfLVAD recipients were older, had a greater body mass index, and more often had diabetes than did pLVAD and non-LVAD patients. The cfLVAD cohort received hearts from older, more often male donors, with a greater body mass index. Post-transplant survival was not significantly different among the 3 groups on Kaplan-Meier analysis (P = .12).
Conclusions:
Despite being older, less favorable recipients, the cfLVAD patients spent more time in status 1A and had greater waitlist survival. This might allow cfLVAD patients to receive preferred donor hearts, which might allow for better post-transplant survival.
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