Impact of the UNOS Policy Allocation Change on Waitlist Outcomes in Patients Bridged to Heart Transplantation on Impella

Purpose The 2018 UNOS heart allocation policy change was intended to prioritize sicker patients while also improving waitlist outcomes. We sought to compare competing outcomes for patients bridged to heart transplantation using Impella devices one year prior to and after the UNOS Allocation Policy change in October 2018. Methods The UNOS database was queried for all adult patients in whom an Impella device (CP/5.0) was used as a bridge to heart transplantation in the 12 month period before and after the UNOS policy change. 28 patients in the pre-policy change and 56 patients in the post-policy change were supported with Impella and underwent heart transplantation. Patients who were younger than 18 years old, lost to follow-up, or who had multi-organ transplant were excluded. Baseline characteristics were compared using Mann-Whitney U test and Chi-square test as appropriate. Competing outcomes analysis was performed to compare (1) death or deterioration, (2) heart transplant or recovery, or (3) continuation on waitlist at 6 months. Results There were no differences between the pre- and post-allocation change groups in regards to recipient age, donor age, gender, ethnicity, ischemic time, and serum creatinine at time of transplant, and hemodynamics. Patients in the post-policy change group had greater rates of transplantation (76.7% vs 39.3%, p Conclusion Impella devices were used more frequently in the one year after the allocation policy change. Early after the UNOS allocation policy change, patients bridged with Impella were more likely to be transplanted however with no difference in waitlist mortality. Additional analysis is needed to better understand whether these results will persist over time as more patients are transplanted with Impella support.