Impact of new allocation policy on waitlist and transplant outcomes of adult congenital heart patients supported with ECMO

IF 2.2 3区医学 Q3 ENGINEERING, BIOMEDICAL Artificial organs Pub Date : 2024-03-14 DOI:10.1111/aor.14738

Shriprasad R. Deshpande, Bibhuti Das, Akshay Kumar, Pranava Sinha, Bahaaldin Alsoufi, Jaimin Trivedi

{"title":"Impact of new allocation policy on waitlist and transplant outcomes of adult congenital heart patients supported with ECMO","authors":"Shriprasad R. Deshpande, Bibhuti Das, Akshay Kumar, Pranava Sinha, Bahaaldin Alsoufi, Jaimin Trivedi","doi":"10.1111/aor.14738","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The use of ECMO as a bridge to heart transplantation has been growing rapidly in all heart transplant recipients since the implementation of the new UNOS allocation policy; however, the impact on adult congenital heart disease (ACHD) patients is not known.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We analyzed the UNOS data (2015–2021) for ACHD patients supported with extracorporeal membrane oxygenation (ECMO) during the waitlist, before and after October 2018, to assess the impact on the waitlist and posttransplant outcomes. We compared the characteristics and outcomes of ACHD patients with or without ECMO use during the waitlist and pre- and postpolicy changes.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 23 821 patients underwent heart transplantation, and only 918 (4%) had ACHD. Out of all ACHD patients undergoing heart transplants, 6% of patients in the prepolicy era and 7.6% in the postpolicy era were on ECMO at the time of listing. Those on ECMO were younger and sicker compared to the rest of the ACHD cohort. Those on ECMO had similar profiles pre- and postpolicy change; however, there was a very significant decrease in the waitlist time [136 days (IQR 29–384) vs. 38 days (IQR 11–108), <i>p</i> = 0.01]. There was no difference in waitlist mortality; however, competing risk analyses showed a higher likelihood of transplantation (51% vs. 29%) and a lower likelihood of death or deterioration (31% vs. 42%) postpolicy change. Long-term outcomes posttransplant for those supported with ECMO compared to the non-ECMO cohort are similar for ACHD patients, although there was higher attrition in the first year for the ECMO cohort.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>The new allocation policy has resulted in shorter waitlist times and a higher likelihood of transplantation for ACHD patients supported by ECMO. However, the appropriate use of ECMO and the underuse of durable circulatory support devices in this population need further exploration.</p>\n </section>\n </div>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Artificial organs","FirstCategoryId":"5","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/aor.14738","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ENGINEERING, BIOMEDICAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The use of ECMO as a bridge to heart transplantation has been growing rapidly in all heart transplant recipients since the implementation of the new UNOS allocation policy; however, the impact on adult congenital heart disease (ACHD) patients is not known.

Methods

We analyzed the UNOS data (2015–2021) for ACHD patients supported with extracorporeal membrane oxygenation (ECMO) during the waitlist, before and after October 2018, to assess the impact on the waitlist and posttransplant outcomes. We compared the characteristics and outcomes of ACHD patients with or without ECMO use during the waitlist and pre- and postpolicy changes.

Results

A total of 23 821 patients underwent heart transplantation, and only 918 (4%) had ACHD. Out of all ACHD patients undergoing heart transplants, 6% of patients in the prepolicy era and 7.6% in the postpolicy era were on ECMO at the time of listing. Those on ECMO were younger and sicker compared to the rest of the ACHD cohort. Those on ECMO had similar profiles pre- and postpolicy change; however, there was a very significant decrease in the waitlist time [136 days (IQR 29–384) vs. 38 days (IQR 11–108), p = 0.01]. There was no difference in waitlist mortality; however, competing risk analyses showed a higher likelihood of transplantation (51% vs. 29%) and a lower likelihood of death or deterioration (31% vs. 42%) postpolicy change. Long-term outcomes posttransplant for those supported with ECMO compared to the non-ECMO cohort are similar for ACHD patients, although there was higher attrition in the first year for the ECMO cohort.

Conclusion

The new allocation policy has resulted in shorter waitlist times and a higher likelihood of transplantation for ACHD patients supported by ECMO. However, the appropriate use of ECMO and the underuse of durable circulatory support devices in this population need further exploration.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

新分配政策对使用 ECMO 支持的成人先天性心脏病患者的候诊和移植结果的影响。

背景：自新的 UNOS 分配政策实施以来，ECMO 作为心脏移植的桥梁在所有心脏移植受者中的使用迅速增长；然而，对成人先天性心脏病（ACHD）患者的影响尚不清楚：我们分析了 2018 年 10 月之前和之后，在等待名单期间接受体外膜氧合（ECMO）支持的 ACHD 患者的 UNOS 数据（2015-2021 年），以评估对等待名单和移植后预后的影响。我们比较了ACHD患者在等待期间和政策变更前后使用或未使用ECMO的特征和预后：共有 23 821 名患者接受了心脏移植手术，其中只有 918 人（4%）患有 ACHD。在所有接受心脏移植的 ACHD 患者中，有 6% 的患者在政策出台前和 7.6% 的患者在政策出台后接受了 ECMO 治疗。与其他 ACHD 患者相比，使用 ECMO 的患者更年轻、病情更严重。接受 ECMO 治疗的患者在政策改变前后的情况相似，但等待时间显著缩短[136 天 (IQR 29-384) vs. 38 天 (IQR 11-108)，p = 0.01]。候选者死亡率没有差异；但竞争风险分析表明，政策改变后移植的可能性更高（51% 对 29%），死亡或病情恶化的可能性更低（31% 对 42%）。与非ECMO队列相比，接受ECMO支持的ACHD患者移植后的长期疗效相似，但ECMO队列第一年的自然减员率较高：结论：新的分配政策缩短了 ECMO 支持的 ACHD 患者的等待时间，提高了他们接受移植的可能性。结论：新的分配政策缩短了 ECMO 支持的 ACHD 患者的候诊时间，并提高了他们接受移植的可能性。然而，在这一人群中，ECMO 的合理使用和持久循环支持设备的使用不足仍需进一步探讨。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Artificial organs 工程技术-工程：生物医学

CiteScore

4.30

自引率

12.50%

发文量

303

审稿时长

4-8 weeks

期刊介绍： Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.