Complications and Status Upgrades among Adult Heart Transplant Candidates with Durable LVADs: Waiting 6 to 8 Years

Related Experiment Video

Updated: Jan 16, 2026

Implantation of the Syncardia Total Artificial Heart
16:11

Implantation of the Syncardia Total Artificial Heart

Published on: July 18, 2014

36.0K

Daniel J Ahn1,2, Antony Attia1,2, Toshihiro Nakayama1,2

  • 1Department of Surgery, Stanford University, Stanford, CA.

Medrxiv : the Preprint Server for Health Sciences
|October 3, 2025
PubMed

Insights

Nearly 40% of durable left ventricular assist device (LVAD) recipients experience complications or status upgrades within 6 years. The upcoming Organ Procurement and Transplantation Network (OPTN) policy change is unlikely to significantly alter heart transplant waitlist priority.

Area of Science:

  • Cardiology and Transplant Medicine
  • Medical Device Technology
  • Health Policy and Management

Background:

  • The 2018 Organ Procurement and Transplantation Network (OPTN) policy shift reduced durable left ventricular assist device (LVAD) listings and transplants, favoring temporary mechanical circulatory support for heart transplant bridging.
  • A new OPTN policy, effective September 2026, will grant statuses 3 and 2 to patients with durable LVADs after 6 and 8 years, respectively.

Purpose of the Study:

  • To evaluate the cumulative incidence of status upgrades and durable LVAD-related complications in adult heart transplant candidates.
  • To assess the potential impact of the upcoming OPTN policy change on heart transplant waitlist composition and patient prioritization.

Main Methods:

  • Analysis of OPTN data for adult heart transplant candidates with durable LVADs implanted between October 18, 2018, and May 31, 2025.
  • Estimation of cumulative incidence of status upgrades and LVAD-related complications, with transplantation and waitlist removal as competing events.
  • Simulation of waitlist composition changes under the prospective OPTN policy.

Main Results:

  • 3,881 adult patients received durable LVADs; Abbott HeartMate 3 was the most common device (82.0%).
  • 38.6% of patients experienced complications or status upgrades, with a cumulative incidence of 38.6% [95% CI (37.1%, 40.2%)].
  • The upcoming policy change would have instantaneously increased priority status for only 0.06% of the waitlist on June 1, 2025.

Conclusions:

  • The cumulative incidence of status upgrades and complications approaches 40% within 6 years for durable LVAD heart transplant candidates.
  • The new OPTN policy, granting automatic status upgrades after 6 and 8 years of LVAD support, is unlikely to substantially impact waitlist prioritization.
  • Current complication and upgrade rates suggest the policy may not significantly alter the dynamics of heart transplant allocation for LVAD patients.
Abstract

More Related Videos

Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems08:49

Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems

Published on: August 2, 2024

1.3K
Implantation of Total Artificial Heart in Congenital Heart Disease07:27

Implantation of Total Artificial Heart in Congenital Heart Disease

Published on: July 18, 2014

25.1K

Related Concept Videos

Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
338
Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
468
Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
255
Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
340
Heart Failure IV: Classification and Diagnostic Evaluation01:30

Heart Failure IV: Classification and Diagnostic Evaluation

Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
319
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
218