No Survival Benefit in Transplanting Stable LVAD Patients (Status 4).

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

Journal of Cardiac Failure

Abstract

Introduction: The Heart Transplant (HT) allocation system prioritizes transplantation based on the likelihood of waitlist mortality (urgency) and doesn't incorporate post-transplant survival. Stable LVAD-supported patients have a low priority for HT. Currently, a new allocation system is being developed that would increase the chances of transplanting stable LVAD-supported patients. Our objective was to analyze the net benefit of receiving HT on LVAD patients according to their listing and transplant status.

Methods: Adult patients who were supported by durable LVAD at the time of listing and at the time of HT who were registered in the UNOS database between October 18, 2018, and June 30, 2022, were included in this study. Patients listed for dual organs or re-transplantation were excluded. One-year survival in the waitlist and after HT was calculated at each listing or transplant status. The net benefit within each status was calculated in days, by subtracting the survival after transplantation from the survival in the waitlist.

Results: A total of 2117 HM3 patients were listed for HT during the study period. Of these 899 were not transplanted within 1 year of listing. The survival at 1 year of these patients was 37.5%, 51.9%, 87.8%, and 94.5% for status 1, 2, 3, and 4 respectively. During the same study period, a total of 1440 HM3 patients received HT. The one-year survival after HT was 94%, 90.1%, 89.5%, and 88.9% for patients transplanted status 1,2,3, and 4 respectively. Patients transplanted as status 1, and 2 had a net positive survival benefit after transplantation of 168.7 and 135.3 days respectively (p< 0.001). Patients transplanted as status 3 had a neutral benefit from transplantation, whereas patients who were transplanted as status 4 had a net negative survival benefit of 15.9 days (p < 0.01)(Figure 1).

Conclusion: In terms of survival, transplanting stable HM3 LVAD patients listed as status 4 doesn't offer an advantage to patients. Informed shared decision-making is of critical importance when considering transplanting a stable HM3 patient.

Volume

31

Issue

1

First Page

262

Comments

Heart Failure Society of America (HFSA) Annual Scientific Meeting, September 27-30, 2024, Atlanta, GA

Last Page

263

DOI

10.1016/j.cardfail.2024.10.209

ISSN

1532-8414

Link to Full Text

Share

COinS