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Extracorporeal Membrane Oxygenation Bridge to Heart Transplant: Trends Following the Allocation Change
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  • Nicholas Hess,
  • Gavin Hickey,
  • Ibrahim Sultan,
  • Arman Kilic
Nicholas Hess
University of Pittsburgh Medical Center
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Gavin Hickey
University of Pittsburgh Medical Center Health System
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Ibrahim Sultan
University of Pittsburgh
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Arman Kilic
University of Pittsburgh Medical Center Health System
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Abstract

Background: This study compared outcomes of patients bridged with extracorporeal membrane oxygenation (ECMO) to orthotopic heart transplantation (OHT) following the recent heart allocation policy change. Methods: The United Network of Organ Sharing Registry (UNOS) database was queried to examine OHT patients between 2010-2020 that were bridged with ECMO. Waitlist outcomes and one-year posttransplant survival were compared between patients waitlisted and/or transplanted before and after the heart allocation policy change. Secondary outcomes included posttransplant stroke, renal failure, and one-year rejection. Results: 285 waitlisted patients were included, 173 (60.7%) waitlisted under the old policy and 112 (39.3%) under the new policy. New policy patients were more likely to receive OHT (82.2% vs 40.6%), and less likely to be removed from the waitlist due to death or clinical deterioration (15.0% vs 41.3%) (both P<0.001). 165 patients bridged from ECMO to OHT were analyzed, 72 (43.6%) transplanted during the old policy and 93 (56.3%) under the new. Median waitlist time was reduced under the new policy (4 days [IQR 2-6] vs 47 days [IQR 10-228]). Postoperative renal failure was higher in the new policy group (23% vs 6%; P=0.002), but rates of stroke and one-year acute rejection were equivalent. One-year survival was lower the new policy but was not significant (79.8% vs 90.3%; P=0.3917). Conclusions: The UNOS heart allocation policy change has resulted in decreased waitlist times and higher likelihood of transplant in patients supported with ECMO. Posttransplant one-year survival has remained comparable although absolute rates are lower.

Peer review status:Published

26 Aug 2020Submitted to Journal of Cardiac Surgery
27 Aug 2020Submission Checks Completed
27 Aug 2020Assigned to Editor
27 Aug 2020Reviewer(s) Assigned
16 Sep 2020Review(s) Completed, Editorial Evaluation Pending
16 Sep 2020Editorial Decision: Revise Major
02 Oct 20201st Revision Received
03 Oct 2020Submission Checks Completed
03 Oct 2020Assigned to Editor
03 Oct 2020Reviewer(s) Assigned
03 Oct 2020Review(s) Completed, Editorial Evaluation Pending
03 Oct 2020Editorial Decision: Accept
14 Oct 2020Published in Journal of Cardiac Surgery. 10.1111/jocs.15118