Effect of UNOS policy change and exception status request on outcomes in patients bridged to heart transplant with an intra‐aortic balloon pump

2021 ◽  
Author(s):  
Aaron M. Wolfson ◽  
Eugene C. DePasquale ◽  
Vaughn A. Starnes ◽  
Mark Cunningham ◽  
Craig Baker ◽  
...  
Keyword(s):  
Policy Change ◽  
Heart Transplant ◽  
Intra Aortic Balloon Pump ◽  
Unos Policy

Abstract 14418: Association Between 2018 Unos Heart Transplant Policy Changes and Likelihood of Transplant for Patients in Rural versus Urban Settings

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Khadijah Breathett ◽  
Shannon Knapp ◽  
Daniel Addison ◽  
Nishaki Mehta ◽  
Nancy Sweitzer ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Policy Change ◽  
Heart Transplant ◽  
Geographic Location ◽  
Geographic Area ◽  
Policy Changes ◽  
Rural Settings ◽  
Significant Difference ◽  
Geographic Setting ◽  
Unos Policy

Introduction: United Network for Organ Sharing (UNOS) recently extended the radius for which a heart transplant candidate can be matched with a donor in order to improve transplantation access for the most critically-ill patients. However, this means that smaller transplant centers serving rural populations may not retain the hearts that were donated within their geographic area. It is unknown whether the UNOS policy change of 2018 was associated with differences in likelihood of heart transplantation or death on the waiting list for patients from rural versus urban (metropolitan or micropolitan) settings. Methods: Using the Scientific Registry of Transplant Recipients, we analyzed U.S. adult patients who were listed for heart transplant from January 2017 through January 2020. Patients were stratified by home zipcodes to either metropolitan, micropolitan, or rural settings. Fine and Gray proportional hazard regression models were used to estimate the sub-distribution hazard ratio (SHR) of heart transplantation with death or removal from transplant list as a competing event according to geographic residence with date of UNOS policy change October 18 2018 as a time-varying covariate. Interaction (p-int) tests were performed between geographic setting and time of policy change. Results: Among 8756 patients, 82% were from metropolitan, 9% micropolitan, and 9% rural settings. The 2018 UNOS policy change was associated with increased receipt of heart transplantation within each geographic setting [metropolitan SHR 1.41 (95%CI: 1.33-1.50); micropolitan SHR 1.30 (95%CI: 1.08-1.56); rural SHR 1.33 (95%CI: 1.10-1.62); p-int=0.60]. Policy changes were not significantly associated with death on the transplant list for any geographic setting [metropolitan SHR 0.97 (95%CI: 0.82-1.14); micropolitan SHR 1.25 (95%CI: 0.80-1.96); rural SHR 0.89 (95%CI: 0.55-1.46); p-int=0.52]. Conclusions: Independent of geographic location, the 2018 UNOS policy change for heart transplantation was associated with increased heart transplantation and no significant difference in hazard of death. Additional follow-up is needed to determine whether improvements are sustained.

Intra-aortic balloon pump as a bridge therapy to heart transplant in refractory heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G.A.B Boros ◽  
V.S.C Bellini ◽  
D Fatori ◽  
C Bernoche ◽  
M.F Macatrao-Costa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care ◽  
Heart Transplant ◽  
Insertion Site ◽  
Laboratory Data ◽  
Central Venous Oxygen Saturation ◽  
Single Center ◽  
Intra Aortic Balloon Pump ◽  
The Impact ◽  
Bridge Therapy

Abstract Background The role of intra-aortic balloon pump (IABP) in advanced heart failure (HF) treatment is still under debate. Some heart transplant (HTx) candidates on the waiting list require mechanical support, and IABP may be the simple and most available device. Purpose Describe the impact of IABP treatment in advanced HF patients who underwent HTx. Methods We retrospectively analysis patients who underwent HTx from a single center intensive care unit (ICU), between 2009 and 2018, to evaluate the use of IABP as bridge therapy. Selection included decompensated chronic HF patients that required intensive care with optimized intravenous drugs before IABP placement. Exclusion criteria were acute myocardial infarction or cardiac surgery 90 days prior to admission, and implant of ventricular assist device before HTx. Results We included 134 HF patients with IABP therapy before HTx. Insertion site was exclusively femoral. Mean time of IABP onset to HTx were 26±21 days, and hospital admission to HTx 65±45 days. The main cardiomyopathy etiology was Chagas Disease (46%) and mean LVEF was 23±6% (TABLE 1). Clinical and laboratory data were compared before and 96 hours after IABP therapy. Mean central venous oxygen saturation (SvO2) increased from 49.7±14.6% to 67.4±11.3% (p<0.001), creatinine decreased from 1.77±0.9 mg/dL to 1.40±0.6 mg/dL (p<0.001), and urine output increased from 1552±886 mL/24h to 2189±1029 mL/24h (p<0.001). These differences were sustained or improved until the day before HTx (FIGURE 1). After 96 hours dobutamine was maintained in 98% of patients, nitroprusside increased from 56% to 67%, milrinone decreased from 26% to 20%, and norepinephrine decreased from 18% to 3%. Significant IABP complications were few (5.2%; n=7: 3 infections, 2 major bleeding, 2 arterial injury). Conclusion In this single center ICU sample, IABP improved hemodynamic status and renal function in refractory HF patients waiting for HTx. IABP can be a reasonable, available and effective bridging therapy. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals COMPARISON OF SIX-MONTHS OUTCOMES IN PATIENTS BRIDGED TO HEART TRANSPLANT (HT) WITH INOTROPES BEFORE AND AFTER UNOS HEART ALLOCATION POLICY CHANGE

2020 ◽  
Vol 75 (11) ◽  
pp. 938
Author(s):  
Grace Liu ◽  
Eugene Christopher DePasquale ◽  
Joseph Rahman ◽  
Kruti Pandya ◽  
Darko Vucicevic ◽  
...  
Keyword(s):  
Policy Change ◽  
Heart Transplant ◽  
Allocation Policy ◽  
Before And After

scholarly journals Comparison of Intra-Aortic Balloon Pump Use and Survival before and after the 2018 UNOS Allocation Policy Change

2021 ◽  
Vol 40 (4) ◽  
pp. S111-S112
Author(s):  
C.P. Bradley ◽  
R. Lee ◽  
S. Hashmi ◽  
P. Kingsford ◽  
A.S. Vaidya ◽  
...  
Keyword(s):  
Policy Change ◽  
Allocation Policy ◽  
Intra Aortic Balloon Pump ◽  
Before And After

Impact of the 2006 Donor Heart Allocation UNOS Policy Using Median Waitlist Times for Patients Awaiting Heart Transplant.

2014 ◽  
Vol 98 ◽  
pp. 426
Author(s):  
J. Kobashigawa ◽  
J. Patel ◽  
M. Kittleson ◽  
F. Liou ◽  
Z. Yu ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Donor Heart ◽  
Unos Policy
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