Mechanical Circulatory Support Use in the Context of Updated Heart Transplant Allocation Policy in the U.S. - Analysis of OPTN Data

Summary of Objectives The goals of the October 2018 U.S. heart allocation policy update were to improve geographical equity in access to heart transplant, decrease waitlist mortality, and improve objectiveness of listing status criteria. Compared to the previous algorithm, patients with endovascular and non-dischargeable mechanical circulatory support (MCS) currently receive the highest priority, while patients with stable durable LVAD and inotropic support receive lower priority on the waiting list. Our aim is to describe changes in the clinical profile of patients transplanted one full year before and after the change. Methods We have established a detailed data analysis plan that will examine the 12-month period before and after the change. We will describe baseline clinical characteristics of patients listed and transplanted in the two eras including proportion with IABP, percutaneous MCS devices (pMCSD) devices, ECMO, non-dischargeable LVAD, and durable LVAD support. We will report (1) listings including their characteristics, transplants, and transplant rates for patients in the different status categories/treatment modalities, (2) waitlist mortality, and (3) 30-day post-transplant survival in the two eras. Endpoints A late-breaking clinical science submission provides extra time necessary to accrue OPTN data to present the heart transplant community with the results of a full year of experience with the new allocation system. We anticipate identifying major changes in the utilization of transplant bridging strategies and identification of clinical approaches and patient cohorts that may be associated with a particular risk of post-transplant mortality as supported by preliminary analysis at 6 months pre- and post-allocation change (Figure). Our findings may suggest areas where additional modifications of the allocation algorithm are needed to bring system performance closer to the overarching goals of just and equitable organ allocation.