Characterizing Survival for Patients Supported With Inotropes After the 2018 Donor Allocation Restructuring: A UNOS...

Area of Science:

• Cardiology
• Transplantation Medicine
• Public Health Policy

Background:

• The 2018 revision of the United Network for Organ Sharing (UNOS) donor heart allocation policy aimed to adapt to changing transplant landscapes.
• Understanding the impact of this policy on patient selection and outcomes, particularly for those requiring inotropic support, is crucial.

Purpose of the Study:

• To characterize adaptive changes in heart transplant (HTx) candidate management following the 2018 UNOS policy revision.
• To estimate long-term survival trends for HTx recipients in relation to inotropic support and mechanical circulatory support devices.

Main Methods:

• Retrospective analysis of UNOS database for patients listed for HTx before (July 2014-July 2016) and after (October 2018-October 2020) the policy revision.
• Examined trends in device progression (inotropes to ECMO, LVAD, tMCS, IABP) and survival post-transplantation.

Main Results:

• The post-policy period saw increased transplantation rates for patients supported with intra-aortic balloon pump (IABP), temporary mechanical circulatory support (tMCS), and extracorporeal membranous oxygenator (ECMO).
• Fewer patients were transplanted on inotropes or durable left ventricular assist devices (LVADs) post-policy, with a significant increase in progression from inotropes to other support forms.
• Waitlisted patients post-policy had higher transplantation rates (89.8% vs. 78.9%) and improved survival (19.1% mortality vs. 26.9%).

Conclusions:

• The 2018 UNOS policy revision shifted utilization towards temporary support devices (ECMO, tMCS, IABP) and away from durable LVADs.
• Policy revisions resulted in increased transplantation and improved survival for patients on inotropes.
• Survival rates were comparable across different forms of temporary support utilized post-transplantation.