IMPROVED SURVIVAL AFTER HEART TRANSPLANTATION IN PATIENTS BRIDGED WITH ECMO IN THE NEW ALLOCATION SYSTEM

Abstract Background Historically, patients bridged on extracorporeal membrane oxygenation (ECMO) to heart transplantation (HT) have very high post-transplant mortality. In the new HT allocation system, ECMO supported patients have the highest priority for HT. However, data is lacking on outcomes of these critically ill patients. We compared waitlist and post-transplant outcomes of ECMO supported patients in the new and old allocation systems. Methods Adult patients supported by ECMO at the time of listing or transplantation registered in the UNOS database between November 1, 2015 and September 30, 2019, were included. Clinical characteristics, outcomes in the waitlist and post-transplant survival were compared between the old and new systems. Cox proportional hazard and sub-distribution hazard regression models were used to evaluate the variables contributing to the outcomes post-transplant and in the waitlist. Results A total of 296 ECMO supported patients were listed for HT. Of these, 191 were distributed to the old system and 105 to the new system. Patients listed in the new system had a higher cumulative incidence of HT (p Conclusions With the implementation of the new HT allocation system, ECMO supported patients have a shorter waitlist time, improved frequency of HT and improved short-term post-transplant survival.