Trends in Left Ventricular Assist Device Utilization and Survival Outcomes Following the Donor Allocation Policy...

Area of Science:

• Cardiology
• Transplantation Medicine
• Medical Device Technology

Background:

• The United Network for Organ Sharing (UNOS) revised its donor heart allocation policy.
• This study examines the impact of this policy revision on durable left ventricular assist device (LVAD) utilization and patient outcomes.
• Trends in LVAD use, waitlist survival, and post-transplant survival were analyzed in relation to the policy change.

Purpose of the Study:

• To estimate trends in durable left ventricular assist device (LVAD) use among heart transplant candidates.
• To evaluate the association between the UNOS donor heart allocation policy revision and LVAD utilization.
• To compare waitlist and post-transplant survival rates for LVAD-supported patients before and after the policy revision.

Main Methods:

• Adult patients implanted with HeartMate II, HeartWare HVAD, or HeartMate 3 LVADs and listed for heart transplantation were identified in the UNOS database.
• Patients were stratified into pre- and post-policy revision groups (October 18, 2013 - June 16, 2023).
• Exclusion criteria included temporary support, other mechanical circulatory support devices, donation after circulatory death hearts, and multiorgan transplants. Waitlist and post-transplant survival were compared.

Main Results:

• LVAD use decreased at listing (28% to 24.5%) and at transplant (45.8% to 31.7%) post-policy revision.
• A higher proportion of LVAD patients underwent transplantation post-policy (89.6% to 94.3%).
• Overall waitlist and post-transplant survival for LVAD-supported patients significantly worsened after the policy change (p < 0.01).

Conclusions:

• The UNOS policy revision was associated with a decline in durable LVAD utilization.
• LVAD-supported patients experienced worse waitlist and post-transplant survival outcomes in the post-policy era.
• The findings highlight potential adverse effects of the allocation policy on outcomes for patients requiring mechanical circulatory support.