Race, Temporary Mechanical Circulatory Support, and Clinical Outcomes after the 2018 US Adult Heart Allocation System Policy Change

Purpose Patients awaiting heart transplant (HTx) with temporary mechanical circulatory support (tMCS) are at high risk of waitlist mortality and are accorded higher priority under the 2018 US adult heart allocation system. To examine the effect of policy changes on racial equity, we examined outcomes based on race in these high risk patients. Methods UNOS registry was queried for adults listed for heart transplant (HTx) 1-year before and after the October 18, 2018 policy change. We examined association of race with use of tMCS (IABP+ ECMO+ percutaneous LVAD+ surgical temporary LVAD), access to transplant organs within 1-year of listing in the pre- and post-era, and 1-year post-transplant mortality. Results Of 8,015 patients listed for HTx, 62.7 % were White and 37.3% Non-White. In the pre-policy era, 290 of 4,027 (7.2%) were listed with tMCS vs 649 of 3,988 (16.3%) in the post era (p Conclusion In the current allocation policy era, the proportion of non-White patients listed for HTx with tMCS appears to be lower compared to Non-White patients, the reasons for which need to be further elucidated. However, in patients who receive tMCS bridge, waitlist mortality, transplant rate, and 1-year post-transplant survival are similar, regardless of race.