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

We sought to estimate left ventricular assist device use (LVAD) with waitlist and post-transplant survival trends in patients supported on durable LVAD in relation to the UNOS donor heart allocation policy revision.

Adult patients implanted with HeartMate II LVAD, HeartWare HVAD, or HeartMate 3 LVAD, and listed for isolated heart transplantation between October 18, 2013, and June 16, 2023, were identified in the UNOS database and were stratified into pre- and post-policy revision groups. Patients on temporary circulatory support, right, or biventricular assist devices, total artificial hearts, recipients of donation after circulatory death (DCD) hearts, and those undergoing simultaneous multiorgan transplants were excluded. Waitlist and post-transplant survival were compared between the groups.

Policy revision was associated with a decrease in LVAD use both at the time of listing (pre: 28% vs. post: 24.5%, p < 0.01) and at the time of transplant (pre: 45.8% vs. post: 31.7%, p < 0.01). For those listed with an LVAD, more patients eventually underwent transplantation (pre: 89.6% vs. post: 94.3%, p < 0.01) following the policy change. Overall waitlist and post-transplant survival among patients supported on LVAD worsened following the policy change, both showing statistical significance (p < 0.01).

In the post-policy era, a decline in durable LVAD utilization was observed, along with worse waitlist and post-transplant outcomes among LVAD-supported patients.