Post-Transplant Outcomes in LVAD-BTT Patients: Differences Based on Order of Acceptance of Donor Organs

PurposeIn the new heart transplant (HT) allocation system patients, (pts) with durable left ventricular assist device (LVAD) have worse outcomes. Donor hearts are allocated to recipients according to pre-specified criteria (urgency, blood type, size, HLA profile, etc). If an organ is not accepted by the selected center it will be offered to the next center. Unsuitable organs may be rejected by multiple centers. We studied the post-transplant outcomes on LVAD-BTT patients according to the order of acceptance of a donor organ.MethodsAdult pts with an LVAD listed for HT between 10/18/2018 and 12/7/2021 & underwent HT in the new system were included in the study. Clinical characteristics of the donor and recipient at time of transplant were compared between groups. Post-transplant survival was compared between organs accepted in <20 offers to those accepted in ≥20 offers.Results859 pts with LVAD received HT. 592 (68.9%) pts received organs accepted in <20 offers and 267 (31.1%) pts received hearts in ≥20 offers. Notable differences between the two groups were (<20 vs ≥20, respectively): organ donors were more often female (19% vs 39% p <0.001), & had worse kidney function (Creatinine 1.7 vs 2.1 p=0.035) . There was more gender mismatch [15% (<20) vs 26% (≥20) p<0.001] and longer ischemic time [3.2 (<20) vs 3.5 hrs (≥20) p<0.001]. LVAD pts who received HT in <20 attempts were more likely to be listed at status 1, 2 or 3 at time of transplant compared to those who received HT in ≥20 offers were often listed status 3 or 4 (P<0.001). Pts with LVADs who received a heart in ≥20 offers had increased survival 365 days post-transplant compared to those who received HT in <20 offers (94% vs 90% p=0.047).ConclusionIn the new system, LVAD-HT pts who received organs that had ≥20 allocation attempts have better post-transplant survival than patients who had <20 allocation attempts. This improved survival was observed despite longer ischemic time, increased donor age and gender mismatch, and is likely due to pts being more stable at the time of HT. In the new heart transplant (HT) allocation system patients, (pts) with durable left ventricular assist device (LVAD) have worse outcomes. Donor hearts are allocated to recipients according to pre-specified criteria (urgency, blood type, size, HLA profile, etc). If an organ is not accepted by the selected center it will be offered to the next center. Unsuitable organs may be rejected by multiple centers. We studied the post-transplant outcomes on LVAD-BTT patients according to the order of acceptance of a donor organ. Adult pts with an LVAD listed for HT between 10/18/2018 and 12/7/2021 & underwent HT in the new system were included in the study. Clinical characteristics of the donor and recipient at time of transplant were compared between groups. Post-transplant survival was compared between organs accepted in <20 offers to those accepted in ≥20 offers. 859 pts with LVAD received HT. 592 (68.9%) pts received organs accepted in <20 offers and 267 (31.1%) pts received hearts in ≥20 offers. Notable differences between the two groups were (<20 vs ≥20, respectively): organ donors were more often female (19% vs 39% p <0.001), & had worse kidney function (Creatinine 1.7 vs 2.1 p=0.035) . There was more gender mismatch [15% (<20) vs 26% (≥20) p<0.001] and longer ischemic time [3.2 (<20) vs 3.5 hrs (≥20) p<0.001]. LVAD pts who received HT in <20 attempts were more likely to be listed at status 1, 2 or 3 at time of transplant compared to those who received HT in ≥20 offers were often listed status 3 or 4 (P<0.001). Pts with LVADs who received a heart in ≥20 offers had increased survival 365 days post-transplant compared to those who received HT in <20 offers (94% vs 90% p=0.047). In the new system, LVAD-HT pts who received organs that had ≥20 allocation attempts have better post-transplant survival than patients who had <20 allocation attempts. This improved survival was observed despite longer ischemic time, increased donor age and gender mismatch, and is likely due to pts being more stable at the time of HT.