Has the New Heart Transplant Donor Allocation Policy Affected Immediate Post-Transplant Care and Outcomes? A Single Center Perspective

Purpose The new UNOS donor heart allocation policy began in October 2018 and prioritized the sickest patients on the heart transplant waitlist. Patients on ECMO and on temporary assist devices now have priority over those less sick patients who are on intravenous inotropes. As a consequence of transplanting sicker patients, post-transplant care and outcomes may be affected. We sought to address this question in our large single-center study. Methods We assessed 116 patients undergoing heart transplantation in the six months prior to October 2018 who were transplanted under status 1A (n=46) compared to patients transplanted the following six months as status 1, 2 or 3 (n=70). Endpoints for comparison in both groups include perioperative mortality, days in the ICU, overall hospital stays and 6-month survival, and the need for transient hemodialysis. Results We saw an increase in the total number of transplants done from 46 prior to the change to 70 after the allocation change. However, the proportion of patient done under urgent status did not change 78.3% vs. 80%. We did however observe an increase in ECMO (0% to 10%) and IABP utilization (11% to 17%). Despite the increase in device use outcome measures didn't show any difference in one year survival 100% pre vs. 92.7% post p=0.1. No statistical differences in ICU LOS, hospital LOS and need for dialysis were observed. Conclusion We observed that the total proportion of urgent transplant did not vary after the change however the use of temporary devices especially ECMO increased post change. This change did not however result in a negative effect of survival or ICU and hospital LOS. More time and a larger patient population is required to fully determine the impact of the new allocation changes on temporary device use and outcome but as of now there doesn't seem to be a negative effect of the increase temporary device use in our large single center institution.