Abstract 12709: Waitlist Survival is Equivalent Between Status 2 Heart Transplant Candidates and Candidates Supported by an Uncomplicated Continuous-Flow Left Ventricular Assist Device
Background: Donor heart allocation priority is based on the level of life support that listed patients require. Patients supported by a continuous-flow (CF) left ventricular assist device (LVAD) have excellent waitlist outcomes, so their status 1B priority requires reevaluation.
Methods: Adults listed for heart transplant (HRT) since the broader regional sharing algorithm was implemented were identified in the UNOS thoracic registry (N=17,380). CF LVAD-supported patients who were listed for or underwent HRT were compared with patients who were listed for or underwent HRT as status 2 (without mechanical or inotropic support). The cumulative incidences of transplant and mortality for waitlisted patients were appraised with competing outcomes analysis. Post-transplant survival was assessed with the Kaplan-Meier method. Analyses were repeated in propensity-matched subgroups. Cox proportional hazards analysis evaluated the effect of pre-listing and pre-transplant characteristics on mortality.
Results: In both unmatched and propensity-matched analyses, HRT candidates supported by a CF LVAD had a similar waitlist mortality rate as status 2 patients yet had a much higher incidence of transplant (Fig 1), and both groups had equivalent post-transplant outcomes (Fig 2). On multivariable analysis, a more recent year of transplant was associated with higher mortality from the time of listing (hazard ratio, 1.03; 95% confidence interval, 1.00-1.07).
Conclusion: These data suggest that uncomplicated CF LVAD patients should be afforded status 2 priority instead of the status 1B priority currently given, unless they sustain a device-related complication.
- © 2013 by American Heart Association, Inc.