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Practice Changes at U.S. Transplant Centers After the New Adult Heart Allocation Policy.
- Source :
-
Journal of the American College of Cardiology (JACC) . Jun2020, Vol. 75 Issue 23, p2906-2916. 11p. - Publication Year :
- 2020
-
Abstract
- <bold>Background: </bold>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.<bold>Objectives: </bold>This study sought to determine the impact of the new policy on the treatment practices of transplant centers.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 07351097
- Volume :
- 75
- Issue :
- 23
- Database :
- Academic Search Index
- Journal :
- Journal of the American College of Cardiology (JACC)
- Publication Type :
- Academic Journal
- Accession number :
- 143732824
- Full Text :
- https://doi.org/10.1016/j.jacc.2020.01.066