Veli K Topkara1, Gabriel T Sayer2, Kevin J Clerkin2, Omar Wever-Pinzon3, Koji Takeda4, Hiroo Takayama4, Craig H Selzman5, Yoshifumi Naka4, Daniel Burkhoff2, Josef Stehlik3, Maryjane A Farr2, James C Fang3, Nir Uriel2, Stavros G Drakos3. 1. Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. Electronic address: vt2113@cumc.columbia.edu. 2. Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. 3. Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah and Salt Lake Veterans Affairs Medical Center, Salt Lake City, Utah, USA. 4. Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA. 5. Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA.
Abstract
BACKGROUND: The 2018 U.S. heart allocation system offers an accelerated pathway for heart transplantation to the most urgent patients. OBJECTIVES: This study sought to determine whether the new allocation system resulted in lower likelihood of candidate recovery. METHODS: Adult patients waitlisted for heart transplantation with temporary mechanical circulatory support at the time of initial listing between 2010 and 2020 in the United Network for Organ Sharing registry were included. Competing events of heart transplantation, waitlist death or delisting for deteriorating condition, and delisting for improved condition (candidate recovery) were analyzed in the new vs old heart allocation system. RESULTS: A total of 688 patients were waitlisted with venoarterial extracorporeal membrane oxygenation or a surgical nondischargeable biventricular assist device (status 1 or old 1A). Overall, 2,237 patients were waitlisted with an intra-aortic balloon pump, a percutaneous left ventricular assist device (LVAD), or a surgical nondischargeable LVAD (status 2 or old 1A). Patients waitlisted with venoarterial extracorporeal membrane oxygenation or a nondischargeable biventricular assist device had significantly shorter median waitlist times (5 vs 31 days), higher incidence for cardiac transplantation (81.5% vs 43.0%), and lower incidence of candidate recovery (1.5% vs 7.9%) in the new vs old heart allocation system (all P < 0.05). Patients waitlisted with an intra-aortic balloon pump or percutaneous or a nondischargeable LVAD also had significantly shorter median waitlist times (8 vs 35 days), higher incidence of transplantation (88.9% vs 64.9%), and lower incidence of candidate recovery (0.2% vs 1.6%) in the new vs old heart allocation system (all P < 0.05). CONCLUSIONS: Current practice of the new allocation system may not offer select temporary mechanical circulatory support patients the opportunity and adequate time to recover to the point of waitlist removal. Further research will determine which patients would benefit from urgent transplantation vs recovery strategy.
BACKGROUND: The 2018 U.S. heart allocation system offers an accelerated pathway for heart transplantation to the most urgent patients. OBJECTIVES: This study sought to determine whether the new allocation system resulted in lower likelihood of candidate recovery. METHODS: Adult patients waitlisted for heart transplantation with temporary mechanical circulatory support at the time of initial listing between 2010 and 2020 in the United Network for Organ Sharing registry were included. Competing events of heart transplantation, waitlist death or delisting for deteriorating condition, and delisting for improved condition (candidate recovery) were analyzed in the new vs old heart allocation system. RESULTS: A total of 688 patients were waitlisted with venoarterial extracorporeal membrane oxygenation or a surgical nondischargeable biventricular assist device (status 1 or old 1A). Overall, 2,237 patients were waitlisted with an intra-aortic balloon pump, a percutaneous left ventricular assist device (LVAD), or a surgical nondischargeable LVAD (status 2 or old 1A). Patients waitlisted with venoarterial extracorporeal membrane oxygenation or a nondischargeable biventricular assist device had significantly shorter median waitlist times (5 vs 31 days), higher incidence for cardiac transplantation (81.5% vs 43.0%), and lower incidence of candidate recovery (1.5% vs 7.9%) in the new vs old heart allocation system (all P < 0.05). Patients waitlisted with an intra-aortic balloon pump or percutaneous or a nondischargeable LVAD also had significantly shorter median waitlist times (8 vs 35 days), higher incidence of transplantation (88.9% vs 64.9%), and lower incidence of candidate recovery (0.2% vs 1.6%) in the new vs old heart allocation system (all P < 0.05). CONCLUSIONS: Current practice of the new allocation system may not offer select temporary mechanical circulatory support patients the opportunity and adequate time to recover to the point of waitlist removal. Further research will determine which patients would benefit from urgent transplantation vs recovery strategy.
Authors: Omar Wever-Pinzon; Stavros G Drakos; Stephen H McKellar; Benjamin D Horne; William T Caine; Abdallah G Kfoury; Dean Y Li; James C Fang; Josef Stehlik; Craig H Selzman Journal: J Am Coll Cardiol Date: 2016-10-04 Impact factor: 24.094
Authors: Ersilia M DeFilippis; Kevin Clerkin; Lauren K Truby; Michael Francke; Justin Fried; Amirali Masoumi; A Reshad Garan; Maryjane A Farr; Hiroo Takayama; Koji Takeda; Nir Uriel; Veli K Topkara Journal: JACC Heart Fail Date: 2021-03-10 Impact factor: 12.035
Authors: A Reshad Garan; Waqas A Malick; Marlena Habal; Veli K Topkara; Justin Fried; Amirali Masoumi; Aws K Hasan; Dimitri Karmpaliotis; Ajay Kirtane; Melana Yuzefpolskaya; Maryjane Farr; Yoshifumi Naka; Dan Burkhoff; Paolo C Colombo; Paul Kurlansky; Hiroo Takayama; Koji Takeda Journal: ASAIO J Date: 2019 Nov/Dec Impact factor: 2.872
Authors: Rebecca Cogswell; Ranjit John; Jerry D Estep; Sue Duval; Ryan J Tedford; Francis D Pagani; Cindy M Martin; Mandeep R Mehra Journal: J Heart Lung Transplant Date: 2019-11-20 Impact factor: 10.247
Authors: Emma J Birks; Stavros G Drakos; Snehal R Patel; Brian D Lowes; Craig H Selzman; Randall C Starling; Jaimin Trivedi; Mark S Slaughter; Pavin Alturi; Daniel Goldstein; Simon Maybaum; John Y Um; Kenneth B Margulies; Josef Stehlik; Christopher Cunningham; David J Farrar; Jesus E Rame Journal: Circulation Date: 2020-10-26 Impact factor: 29.690
Authors: Lauren V Huckaby; Laura M Seese; Michael A Mathier; Gavin W Hickey; Arman Kilic Journal: Circ Heart Fail Date: 2020-08-06 Impact factor: 8.790
Authors: Yi-Tso Cheng; Arthur R Garan; Joseph Sanchez; Paul Kurlansky; Masahiko Ando; Marisa Cevasco; Melana Yuzefpolskaya; Paolo C Colombo; Yoshifumi Naka; Hiroo Takayama; Koji Takeda Journal: Ann Thorac Surg Date: 2019-03-06 Impact factor: 4.330