Related Experiment Video
Updated: Aug 23, 2025
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Increased severe primary graft dysfunction in left ventricular assist device patients following united network for
Aaron Guo1, Kunal Kotkar1, Brandon Jocher1
1Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
Insights
The 2018 UNOS heart allocation changes increased severe primary graft dysfunction in LVAD patients. Blood transfusions were linked to severe PGD, highlighting the need for careful management in heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Device Technology
Background:
- The United Network for Organ Sharing (UNOS) updated its heart allocation system in 2018, prioritizing patients on temporary support and those with complications on a left-ventricular assist device (LVAD).
- These policy changes may affect outcomes for patients bridged to heart transplantation using an LVAD.
Purpose of the Study:
- To evaluate the impact of the 2018 UNOS heart allocation system changes on post-transplant outcomes.
- Specifically, to assess changes in severe primary graft dysfunction (PGD) and other outcomes in heart transplant recipients before and after the policy implementation.
Main Methods:
- A retrospective study was conducted on 168 adult heart transplant recipients between 2016 and 2020.
- Data were collected from chart reviews and national databases, comparing outcomes before and after the UNOS allocation policy change.
- Primary outcome was severe PGD; secondary outcomes included 30-day readmission, 30-day mortality, and 1-year mortality.
Main Results:
- Overall incidence of severe PGD remained similar (10% vs. 15%, p=0.3).
- However, severe PGD significantly increased in the LVAD-bridged cohort (12% vs. 40%, p<0.01).
- Blood transfusion emerged as a predictor of severe PGD (OR 1.3, p<0.01).
Conclusions:
- The updated UNOS heart allocation system led to a notable increase in severe PGD among LVAD-bridged heart transplant recipients.
- While overall readmission and survival rates were unaffected, the findings underscore the vulnerability of LVAD patients post-transplant under the new system.
- Blood transfusions should be carefully managed in this population to mitigate PGD risk.
Introduction:
In 2018, the United Network for Organ Sharing (UNOS) implemented a new heart allocation system which prioritized patients on temporary support devices and left-ventricular assist device (LVAD) patients with complications. These changes have the potential to impact outcomes for patients bridged to transplant with an LVAD.
Methods:
We performed a retrospective study of 168 adult heart transplant recipients at our center between 2016 and 2020 evaluating post-transplant outcomes before and after UNOS allocation changes. Donor and recipient data were retrieved from chart review and national databases. The primary outcome of this study was severe primary graft dysfunction (PGD) with secondary outcomes of 30-day readmission, 30-day mortality, and 1-year mortality.
Results:
Incidence of severe PGD was similar in the overall cohort before and after the changes (10% vs. 15%, respectively, p = .3) and increased in the LVAD-bridged cohort (12% vs. 40%, respectively, p < .01). Secondary outcomes of readmission and survival were similar between all groups. Blood transfusion was predictive of severe PGD in multivariable modeling (OR 1.3 [1.11-1.59], p < .01).
