Acceptable Post–Heart Transplant Outcomes Support Temporary MCS Prioritization in the New OPTN|UNOS Heart Allocation Policy

Reich, Heidi; Ramzy, Danny; Moriguchi, J.; Dimbil, S.; Levine, R.; Passano, Elizabeth; Kittleson, M.; Cole, R.; Czer, L.; Chang, D.; Geft, D.; Trento, Alfredo; Chikwe, Joanna; Kobashigawa, J.A.; Esmailian, F.

doi:10.1016/j.transproceed.2020.04.1819

Cited by 20 publications

(14 citation statements)

References 10 publications

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“…While durable VADs were associated with worsened CKD stage, percutaneous axial flow devices, IABP, ECMO, and temporary VADs were all associated with improved CKD stage between waitlisting and OHT. In the context of recent studies demonstrating largely acceptable post-transplant survival outcomes of temporary MCS, [29][30][31] these findings suggest that temporary MCS may be a preferable option to durable VAD in patients with existing renal insufficiency at listing and those at high risk of developing renal insufficiency while on the waitlist.…”

Section: Discussionmentioning

confidence: 87%

The impact of changes in renal function during waitlist time on outcomes after heart transplantation

Brocklebank

Kwon

Hashmi

et al. 2021

Journal of Cardiac Surgery

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Background and Aim: This study evaluated the impact of changes in renal function during the waitlist period on posttransplant outcomes of orthotopic heart transplantation (OHT). Methods:The United Network for Organ Sharing registry was used to identify adult patients undergoing isolated OHT from 2010 to 2020. Patients were stratified by whether their National Kidney Foundation chronic kidney disease (CKD) stage improved, worsened, or remained unchanged between listing and transplantation. Univariate analysis and multivariableCox regression were conducted to determine whether a change in estimated glomerular filtration rate (eGFR) or change in CKD stage predicted 1-year mortality after OHT. Results: Of 22,746 patients, the majority of patients remained in the same CKD stage (59.6%), and the frequencies of patients progressing to improved (19.3%) and worsened (21.1%) CKD stages were similar. Temporary mechanical circulatory support (MCS) was associated with improved CKD stage and durable MCS with worsened CKD stage (p < .001). Post-OHT dialysis was most common in patients with worsened CKD stage (13.2%) and least common in the improved cohort (9.4%) (p < .001). Kaplan-Meier unadjusted 1-year survival rates after OHT were similar between CKD change groups (log-rank p = .197). Multivariable analysis demonstrated no risk-adjusted effect of change in eGFR (p = .113) or change in CKD stage (p = .076) on 1-year mortality after OHT. Conclusions: Approximately 20% of patients improve CKD stage and 20% worsen CKD stage between listing and OHT, with the remaining 60% having unchanged CKD stage. Worsening CKD stage predicts increased likelihood of post-OHT dialysis, but CKD stage change does not predict 1-year survival following OHT.

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Section: Discussionmentioning

confidence: 87%

The impact of changes in renal function during waitlist time on outcomes after heart transplantation

Brocklebank

Kwon

Hashmi

et al. 2021

Journal of Cardiac Surgery

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“…84,85 The old system utilized three tiers (Status 1A/B and Status 2) while the new system transitioned to Status 1-6 ( Table 1) while broadening geographic boundaries. 86 At first review, preliminary assessment of patients transplanted under the new system (through March 31 st , 2019) reported a decrease in wait-list mortality but unexpectedly poor posttransplant survival rates with an increase in retransplantation as compared to the old system. 87 Cogswell and colleagues emphasized that these early results represented a small sample size (n=529) and further evaluation was needed to determine trends in survival.…”

Section: Update On the New Heart Allocation Systemmentioning

confidence: 99%

“… 84 , 85 The old system utilized three tiers (Status 1A/B and Status 2) while the new system transitioned to Status 1-6 ( Table 1 ) while broadening geographic boundaries. 86 …”

Section: Updates In Heart Transplantationmentioning

confidence: 99%

See 1 more Smart Citation

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2020

Martin

Weiner

Feinman

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…There has been increasing evidence over the past few years that supports the increasing use of temporary or durable MCS devices as a bridge to heart transplant. 2 There has been, however, limited data regarding its use in multiorgan transplant. A recent paper by Afflu and colleagues 3 identified worse outcomes at 1 year post-transplant in combined heart and kidney transplant patients when compared with those transplanted before the allocation prioritization change.…”

mentioning

confidence: 99%

Commentary: Mechanical bridge over troubled waters

Cole

Emerson

Kobashigawa

2023

The Journal of Thoracic and Cardiovascular Surgery

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Disclosures: Dr Kobashigawa serves on the Clinical Events Committee on the Trans-Medics DCD heart transplant clinical trial. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

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Acceptable Post–Heart Transplant Outcomes Support Temporary MCS Prioritization in the New OPTN|UNOS Heart Allocation Policy

Cited by 20 publications

References 10 publications

The impact of changes in renal function during waitlist time on outcomes after heart transplantation

The impact of changes in renal function during waitlist time on outcomes after heart transplantation

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2020

Commentary: Mechanical bridge over troubled waters

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