Authors
Toyokazu Endo, Priyadarshini Chandrashekhar, Michele Gallo, Erin M Schumer, Siddharth Pahwa, Mark S Slaughter, Jaimin R Trivedi
Published in
Clinical transplantation. Volume 39. Issue 8. Pages e70283.
Abstract
The new United Network of Organ Sharing (UNOS) allocation policy emphasizes those supported by mechanical circulatory support devices (MCSD). We evaluated the outcomes based on temporary mechanical circulatory support (TMCS) devices that have a timeline restriction (Status 1: Veno-Arterial Extra-Corporeal Membrane Oxygenation (VA-ECMO) and Status 2: Intra-Aortic Balloon Pump (IABP) and Impella) and extension status among Status 1 and 2 patients.
The UNOS database was used to identify adult patients (age > 17) listed for heart transplants as Status 1 or 2 at any point during their listing from October 2018 to June 2024.
Among Status 1 patients, extensions have stayed steady throughout the years but with significant regional variations across the UNOS region (0%-30.2%). Those extensions granted had worse waitlist outcomes but comparable post-transplant survival. Among Status 2 patients, the use of IABP and Impella has significantly increased over the years, with the use of extensions increased during our study period. The majority of the patients were supported on IABP. Again, regional variations existed with the UNOS region that ranged from 12% to 25% use of the extension. Those who were extended had better waitlist survival, with comparable post-transplant outcomes (p < 0.05).
The timeline restriction for Status 1 and 2 patients with TMCS are not seen in practice with more patients remaining in their respective status through extensions. Extension criteria as well as timeline restriction should be revisited in the UNOS heart allocation policy.
PMID:
40828460
Bibliographic data and abstract were imported from PubMed on 19 Aug 2025.
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