Impact of 2018 UNOS Allocation Policy Change on VAD Outcomes

Purpose In October 2018 the UNOS Allocation Policy for heart transplantation was changed to prioritize more critically-ill patients. Before the allocation change, patients with ventricular assist devices (VADs) were listed as Status 1B which was changed to Status 4. We sought to investigate the impact this change in policy had on survival outcomes. Methods All adult patients who were registered for heart transplantation with VAD for the year before (PRE, n=633) and after (POST, n=567) the UNOS 2018 Allocation policy change were analyzed. Baseline characteristics were compared using Mann-Whitney U test and Chi-square test as appropriate. Kaplan-Meier survival analysis was performed for 6 months post-transplantation. Results There was no difference in 6 month post transplantation survival in VAD patients in PRE and POST groups. Total days on the waiting list was lower in the POST group (median+IQR) (32 [10.0, 96] vs. 59.0 [22.0,121.0]), p Conclusion After the 2018 policy change there was no difference in 6 month survival among patients with VADs compared to prior. There was a shorter wait time to transplantation for patients with VADs in the POST group. Further analysis on implications of UNOS policy changes are warranted.