TY - JOUR
T1 - Practice Changes at U.S. Transplant Centers After the New Adult Heart Allocation Policy
AU - Parker, William F.
AU - Chung, Kevin
AU - Anderson, Allen S.
AU - Siegler, Mark
AU - Huang, Elbert S.
AU - Churpek, Matthew M.
N1 - Funding Information:
The authors acknowledge Nikhil Narang for his assistance with the project by providing relevant clinical information. The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. Dr. Parker has received support from National Institutes of Health (NIH) grant K08 HL150291. Dr. Anderson has consulted for Edwards LifeSciences; and has received research support from Abbott. Dr. Huang has received support from NIH grants K24 DK105340 and P30 DK092949. Dr. Churpek has received support from NIH grant R01 GM123193; has received research support from EarlySense; and has a U.S. patent pending for a risk stratification algorithm for hospitalized patients. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Funding Information:
Dr. Parker has received support from National Institutes of Health (NIH) grant K08 HL150291. Dr. Anderson has consulted for Edwards LifeSciences; and has received research support from Abbott. Dr. Huang has received support from NIH grants K24 DK105340 and P30 DK092949. Dr. Churpek has received support from NIH grant R01 GM123193; has received research support from EarlySense; and has a U.S. patent pending for a risk stratification algorithm for hospitalized patients. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/6/16
Y1 - 2020/6/16
N2 - Background: In October 2018, the U.S. heart allocation system expanded the number of priority “status” tiers from 3 to 6 and added cardiogenic shock requirements for some heart transplant candidates listed with specific types of treatments. Objectives: This study sought to determine the impact of the new policy on the treatment practices of transplant centers. Methods: Initial listing data on all adult heart candidates listed from December 1, 2017 to April 30, 2019 were collected from the Scientific Registry of Transplant Recipients. The status-qualifying treatments (or exception requests) and hemodynamic values at listing of a post-policy cohort (December 2018 to April 2019) were compared with a seasonally matched pre-policy cohort (December 2017 to April 2018). Candidates in the pre-policy cohort were reclassified into the new priority system statuses by using treatment, diagnosis, and hemodynamics. Results: Comparing the post-policy cohort (N = 1,567) with the pre-policy cohort (N = 1,606), there were significant increases in listings with extracorporeal membrane oxygenation (+1.2%), intra-aortic balloon pumps (+ 4 %), and exceptions (+ 12%). Listings with low-dose inotropes (−18%) and high-dose inotropes (−3%) significantly decreased. The new priority status distribution had more status 2 (+14%) candidates than expected and fewer status 3 (−5%), status 4 (− 4%) and status 6 (−8%) candidates than expected (p values <0.01 for all comparisons). Conclusions: After implementation of the new heart allocation policy, transplant centers listed more candidates with extracorporeal membrane oxygenation, intra-aortic balloon pumps, and exception requests and fewer candidates with inotrope therapy than expected, thus leading to significantly more high-priority status listings than anticipated. If these early trends persist, the new allocation system may not function as intended.
AB - Background: In October 2018, the U.S. heart allocation system expanded the number of priority “status” tiers from 3 to 6 and added cardiogenic shock requirements for some heart transplant candidates listed with specific types of treatments. Objectives: This study sought to determine the impact of the new policy on the treatment practices of transplant centers. Methods: Initial listing data on all adult heart candidates listed from December 1, 2017 to April 30, 2019 were collected from the Scientific Registry of Transplant Recipients. The status-qualifying treatments (or exception requests) and hemodynamic values at listing of a post-policy cohort (December 2018 to April 2019) were compared with a seasonally matched pre-policy cohort (December 2017 to April 2018). Candidates in the pre-policy cohort were reclassified into the new priority system statuses by using treatment, diagnosis, and hemodynamics. Results: Comparing the post-policy cohort (N = 1,567) with the pre-policy cohort (N = 1,606), there were significant increases in listings with extracorporeal membrane oxygenation (+1.2%), intra-aortic balloon pumps (+ 4 %), and exceptions (+ 12%). Listings with low-dose inotropes (−18%) and high-dose inotropes (−3%) significantly decreased. The new priority status distribution had more status 2 (+14%) candidates than expected and fewer status 3 (−5%), status 4 (− 4%) and status 6 (−8%) candidates than expected (p values <0.01 for all comparisons). Conclusions: After implementation of the new heart allocation policy, transplant centers listed more candidates with extracorporeal membrane oxygenation, intra-aortic balloon pumps, and exception requests and fewer candidates with inotrope therapy than expected, thus leading to significantly more high-priority status listings than anticipated. If these early trends persist, the new allocation system may not function as intended.
KW - allocation
KW - ethics
KW - heart transplantation
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U2 - 10.1016/j.jacc.2020.01.066
DO - 10.1016/j.jacc.2020.01.066
M3 - Article
C2 - 32527399
AN - SCOPUS:85085624654
VL - 75
SP - 2906
EP - 2916
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 23
ER -