Increased severe primary graft dysfunction in left ventricular assist device patients following united network for organ sharing allocation changes

Abstract

Introduction In 2018, the United Network for Organ Sharing (UNOS) implemented a new heart allocation system which prioritized patients on temporary support devices and left‐ventricular assist device (LVAD) patients with complications. These changes have the potential to impact outcomes for patients bridged to transplant with an LVAD. Methods We performed a retrospective study of 168 adult heart transplant recipients at our center between 2016 and 2020 evaluating post‐transplant outcomes before and after UNOS allocation changes. Donor and recipient data were retrieved from chart review and national databases. The primary outcome of this study was severe primary graft dysfunction (PGD) with secondary outcomes of 30‐day readmission, 30‐day mortality, and 1‐year mortality. Results Incidence of severe PGD was similar in the overall cohort before and after the changes (10% vs. 15%, respectively, p = .3) and increased in the LVAD‐bridged cohort (12% vs. 40%, respectively, p < .01). Secondary outcomes of readmission and survival were similar between all groups. Blood transfusion was predictive of severe PGD in multivariable modeling (OR 1.3 [1.11–1.59], p < .01).

Acute complication posttransplant: primary allograft dysfunction

“…Recipient pulmonary hypertension has been known to be a risk factor for PGD, alongside prolonged amiodarone and temporary mechanical support use [21,22]. Recipients bridged with durable left ventricular assist device also have a higher risk of PGD [23]. A novel recipient risk factor has been identified in those who have preexisting haematological disorders, bleeding and clotting.…”