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Extracorporeal membrane oxygenation bridge to heart transplant: Trends following the allocation change
Author(s) -
Hess Nicholas R.,
Hickey Gavin W.,
Sultan Ibrahim,
Kilic Arman
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15118
Subject(s) - medicine , interquartile range , heart transplantation , extracorporeal membrane oxygenation , stroke (engine) , heart failure , united network for organ sharing , cardiology , transplantation , emergency medicine , mechanical engineering , engineering , liver transplantation
Abstract Background This study compared outcomes of patients bridged with extracorporeal membrane oxygenation (ECMO) to orthotopic heart transplantation (OHT) following the recent heart allocation policy change. Methods The United Network of Organ Sharing Registry (UNOS) database was queried to examine OHT patients between 2010 and 2020 that were bridged with ECMO. Waitlist outcomes and 1‐year posttransplant survival were compared between patients waitlisted and/or transplanted before and after the heart allocation policy change. Secondary outcomes included posttransplant stroke, renal failure, and 1‐year rejection. Results A total of 285 waitlisted patients were included, 173 (60.7%) waitlisted under the old policy and 112 (39.3%) under the new policy. New policy patients were more likely to receive OHT (82.2% vs. 40.6%), and less likely to be removed from the waitlist due to death or clinical deterioration (15.0% vs. 41.3%; both p < .001). A total of 165 patients bridged from ECMO to OHT were analyzed, 72 (43.6%) transplanted during the old policy and 93 (56.3%) under the new. Median waitlist time was reduced under the new policy (4 days [interquartile range {IQR}: 2–6] vs. 47 days [IQR: 10–228]). Postoperative renal failure was higher in the new policy group (23% vs. 6%; p = .002), but rates of stroke and 1‐year acute rejection were equivalent. One‐year survival was lower the new policy but was not significant (79.8% vs. 90.3%; p = .3917). Conclusions The UNOS heart allocation policy change has resulted in decreased waitlist times and higher likelihood of transplant in patients supported with ECMO. Posttransplant 1‐year survival has remained comparable although absolute rates are lower.