UNOS 2018 Heart Allocation Policy: Evaluation of Status 1 and 2 Extensions on Heart Transplant Outcomes

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-08-19 DOI:10.1111/ctr.70283

Toyokazu Endo, Priyadarshini Chandrashekhar, Michele Gallo, Erin M. Schumer, Siddharth Pahwa, Mark S. Slaughter, Jaimin R. Trivedi

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引用次数: 0

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

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UNOS 2018心脏分配政策：评估心脏移植结果的状态1和2扩展

新的联合器官共享网络（UNOS）分配政策强调由机械循环支持装置（MCSD）支持的器官分配。我们基于有时间限制的临时机械循环支持（TMCS）装置（状态1：静脉-动脉体外膜氧合（VA-ECMO）和状态2：主动脉内球囊泵（IABP）和Impella）和状态1和2患者的扩展状态来评估结果。方法使用UNOS数据库，在2018年10月至2024年6月期间的任何时间点，识别列出的心脏移植状态为1或2的成年患者（年龄>； 17）。结果：在状态1的患者中，延长手术多年来一直保持稳定，但在UNOS地区存在显著的区域差异（0%-30.2%）。那些获得延长的患者在等待名单上的结果更差，但移植后的生存率相当。在状态2的患者中，IABP和Impella的使用近年来显著增加，在我们的研究期间，延长的使用也有所增加。大多数患者支持IABP治疗。同样，UNOS区域也存在区域差异，使用扩展的比例从12%到25%不等。延长的患者有更好的等待期生存，移植后的预后比较（p < 0.05）。结论TMCS状态1和状态2患者的时间限制在实践中未见，更多患者通过延长时间保持各自状态。延长标准和时间限制应该在美国联合手术室的心脏分配政策中重新考虑。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.