Impact of New UNOS Allocation Criteria on Heart Transplant Practices and Outcomes
Background. In October 2018, a new heart allocation policy was implemented with intent of prioritizing the sickest patients and decreasing waitlist time. We examined the effects of the new policy on transplant practices and outcomes 1 year before and 1 year after the change. Methods. Transplant reci...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2021-01-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001088 |
| _version_ | 1818644493429112832 |
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| author | Jason Liu, MD, Bin Q. Yang, MD, Akinobu Itoh, MD, PhD, Mohammed Faraz Masood, MD, Justin C. Hartupee, MD, PhD, Joel D. Schilling, MD, PhD |
| author_facet | Jason Liu, MD, Bin Q. Yang, MD, Akinobu Itoh, MD, PhD, Mohammed Faraz Masood, MD, Justin C. Hartupee, MD, PhD, Joel D. Schilling, MD, PhD |
| author_sort | Jason Liu, MD, |
| collection | DOAJ |
| description | Background. In October 2018, a new heart allocation policy was implemented with intent of prioritizing the sickest patients and decreasing waitlist time. We examined the effects of the new policy on transplant practices and outcomes 1 year before and 1 year after the change.
Methods. Transplant recipients from October 2017 to September 2019 at our institution were identified and divided into 2 cohorts, a preallocation and postallocation criteria change. Patient demographics, clinical data, and bridging strategy were assessed. Early outcomes including ischemic time, severe primary graft dysfunction, need for renal replacement therapy, and duration of hospital stay were investigated.
Results. In the 12 months before the change, 38 patients were transplanted as compared to 33 patients in the 12 months after the change. The average wait-time to transplant decreased after the allocation change (49 versus 313 d, P = 0.02). Patients were more likely to be bridged with an intra-aortic balloon pump (45% versus 3%) and less likely to be supported with a durable left ventricular assist device (LVAD) after the change (24% versus 82%). There was an increase in total ischemic time after the change (177 versus 117 min, P ≤ 0.01). There were no significant differences in other early posttransplant outcomes.
Conclusions. Implementation of the new allocation system for heart transplantation resulted in dramatic changes in the bridging strategy utilized at our institution. Temporary mechanical support usage increased following the change and the number of recipients supported with durable LVADs decreased. Early posttransplant outcomes appear similar. |
| first_indexed | 2024-12-17T00:15:44Z |
| format | Article |
| id | doaj.art-7e9fe018669b4968b985dcc05f031bbb |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-12-17T00:15:44Z |
| publishDate | 2021-01-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-7e9fe018669b4968b985dcc05f031bbb2022-12-21T22:10:43ZengWolters KluwerTransplantation Direct2373-87312021-01-0171e64210.1097/TXD.0000000000001088202101000-00008Impact of New UNOS Allocation Criteria on Heart Transplant Practices and OutcomesJason Liu, MD,0Bin Q. Yang, MD,1Akinobu Itoh, MD, PhD,2Mohammed Faraz Masood, MD,3Justin C. Hartupee, MD, PhD,4Joel D. Schilling, MD, PhD51 Department of Medicine, Division of Cardiology, Barnes-Jewish Hospital/Washington University School of Medicine, St. Louis, MO.1 Department of Medicine, Division of Cardiology, Barnes-Jewish Hospital/Washington University School of Medicine, St. Louis, MO.2 Department of Surgery, Division of Cardiothoracic Surgery, Barnes-Jewish Hospital/Washington University School of Medicine, St. Louis, MO.2 Department of Surgery, Division of Cardiothoracic Surgery, Barnes-Jewish Hospital/Washington University School of Medicine, St. Louis, MO.1 Department of Medicine, Division of Cardiology, Barnes-Jewish Hospital/Washington University School of Medicine, St. Louis, MO.1 Department of Medicine, Division of Cardiology, Barnes-Jewish Hospital/Washington University School of Medicine, St. Louis, MO.Background. In October 2018, a new heart allocation policy was implemented with intent of prioritizing the sickest patients and decreasing waitlist time. We examined the effects of the new policy on transplant practices and outcomes 1 year before and 1 year after the change. Methods. Transplant recipients from October 2017 to September 2019 at our institution were identified and divided into 2 cohorts, a preallocation and postallocation criteria change. Patient demographics, clinical data, and bridging strategy were assessed. Early outcomes including ischemic time, severe primary graft dysfunction, need for renal replacement therapy, and duration of hospital stay were investigated. Results. In the 12 months before the change, 38 patients were transplanted as compared to 33 patients in the 12 months after the change. The average wait-time to transplant decreased after the allocation change (49 versus 313 d, P = 0.02). Patients were more likely to be bridged with an intra-aortic balloon pump (45% versus 3%) and less likely to be supported with a durable left ventricular assist device (LVAD) after the change (24% versus 82%). There was an increase in total ischemic time after the change (177 versus 117 min, P ≤ 0.01). There were no significant differences in other early posttransplant outcomes. Conclusions. Implementation of the new allocation system for heart transplantation resulted in dramatic changes in the bridging strategy utilized at our institution. Temporary mechanical support usage increased following the change and the number of recipients supported with durable LVADs decreased. Early posttransplant outcomes appear similar.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001088 |
| spellingShingle | Jason Liu, MD, Bin Q. Yang, MD, Akinobu Itoh, MD, PhD, Mohammed Faraz Masood, MD, Justin C. Hartupee, MD, PhD, Joel D. Schilling, MD, PhD Impact of New UNOS Allocation Criteria on Heart Transplant Practices and Outcomes Transplantation Direct |
| title | Impact of New UNOS Allocation Criteria on Heart Transplant Practices and Outcomes |
| title_full | Impact of New UNOS Allocation Criteria on Heart Transplant Practices and Outcomes |
| title_fullStr | Impact of New UNOS Allocation Criteria on Heart Transplant Practices and Outcomes |
| title_full_unstemmed | Impact of New UNOS Allocation Criteria on Heart Transplant Practices and Outcomes |
| title_short | Impact of New UNOS Allocation Criteria on Heart Transplant Practices and Outcomes |
| title_sort | impact of new unos allocation criteria on heart transplant practices and outcomes |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001088 |
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