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Heart Allocation Change and Multiple Temporary Circulatory Support as Bridge-to-Bridge

Iulia Barbur1, Eric W Etchill2, Katherine Giuliano2

  • 1Johns Hopkins University School of Medicine, Baltimore, Maryland.

The Journal of Surgical Research
|January 14, 2023
PubMed

Insights

The 2018 heart allocation policy change increased use of multiple temporary mechanical circulatory support (mtMCS) devices, leading to faster transplants and improved survival for heart candidates. This policy change significantly benefited patients awaiting heart transplants.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Medical Policy Analysis

Background:

  • The 2018 Organ Procurement and Transplantation Network (OPTN) heart allocation policy aimed to optimize organ distribution.
  • Multiple temporary mechanical circulatory support (mtMCS) devices are used in advanced heart failure patients awaiting transplantation.
  • Understanding the impact of policy changes on mtMCS device utilization and outcomes is crucial.

Purpose of the Study:

  • To investigate the association between the 2018 OPTN heart allocation policy change and the characteristics and outcomes of heart transplant candidates receiving mtMCS.
  • To compare outcomes of mtMCS recipients before and after the policy change.

Main Methods:

  • Retrospective analysis of adult heart transplant candidates listed between October 2014-January 2018 (prepolicy) and October 2018-January 2022 (postpolicy).
  • Utilized data from the United Network of Organ Sharing (UNOS) registry.
  • Compared mtMCS recipients at listing, transplant, 90-days, and 1-year post-transplant using multivariable linear regression and competing risks analysis.

Main Results:

  • A higher proportion of transplant candidates received mtMCS postpolicy (4% vs 1%).
  • Postpolicy, patients received their second device significantly sooner (adjusted 49 days) and reached transplantation faster (adjusted 35 days).
  • Transplantation likelihood increased by 80% postpolicy, with reduced waitlist mortality and improved 90-day and 1-year post-transplant survival.

Conclusions:

  • The 2018 OPTN policy change led to increased utilization of mtMCS devices.
  • Postpolicy, mtMCS recipients experienced a shorter time to transplantation and improved post-transplant survival.
  • Earlier progression to secondary device and transplantation under the new policy is associated with better outcomes.
Abstract

Keywords:
Bridge-to-bridgeExtracorporeal membrane oxygenationHealth policyIntra-aortic balloon pumpTemporary mechanical circulatory supportTransplantation

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