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

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2025-03-04 DOI:10.1111/ctr.70105

Christopher Pritting, Joshua Chen, Abdulmojeed Ekiyoyo, Eric Warner, Yevgeniy Brailovsky, Vakhtang Tchantchaleishvili, Indranee Rajapreyar

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引用次数: 0

Abstract

Background

We sought to characterize adaptive changes to the revised UNOS donor heart allocation policy in 2018 and estimate long-term survival trends for heart transplant (HTx) recipients with respect to inotropic support.

Methods

Patients listed for HTx between July 18, 2014, and July 18, 2016 (prepolicy revision) and between October 18, 2018, and October 18, 2020 (postpolicy revision) were identified from the UNOS database. Sub-analyses examined trends in device progression where patients listed on inotropes were later transplanted on inotropes and/or on extracorporeal membranous oxygenator (ECMO), durable left ventricular assist device (LVAD), temporary mechanical circulatory support (tMCS), or intra-aortic balloon pump (IABP). Survival data post-HTx were calculated and plotted.

Results

Overall, 3,189 patients were waitlisted (pre: 1,408; post: 1,781). Patient demographics differed only by cardiac output, mean PCWP, cigarette use, ventilatory support, and time on the waitlist. Policy revisions were associated with an increase in patients transplanted while supported with IABP (p < 0.01), tMCS (p < 0.01), and ECMO (p < 0.01). In contrast, postpolicy, fewer patients were transplanted while on inotropes (p < 0.01) or an LVAD (p < 0.01), and 57.4% patients progressed from inotropes to another form of support (27.4% prepolicy, p < 0.01). Additionally, waitlisted patients in the postpolicy period were more likely to be transplanted (pre: 78.9% vs. post: 89.8%, p < 0.01) and more likely to survive (mortality, pre: 26.9% vs. post: 19.1, p < 0.01).

Conclusions

Allocation policy revisions have contributed to increased utilization of temporary support (ECMO, tMCS, and IABP) and decreased utilization of others such as durable LVADs. Additionally, revisions have led to improved survival and increased transplantation for patients waitlisted on inotropes, yet similar survival for each individual form of temporary support.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.