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

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.