One-year before and after UNOS Status Change Effect on ECMO as a Bridge to Heart Transplant

Purpose Extracorporeal membrane oxygenation (ECMO) is used as a bridge for the sickest patients awaiting heart transplantation (HT). Herein, we report on six-month post-transplant survival in patients bridged with ECMO in the year before (PRE) and after (POST) the implementation of the updated UNOS Policy allocation system (October 18, 2018). Methods We identified 172 (PRE, N = 27, POST, N-145) adult patients in the UNOS registry that underwent heart transplantation from ECMO during the year before and after UNOS policy change. Baseline clinical characteristics were compared using Mann-Whitney U test and Chi-square test as appropriate. Survival analysis was performed using Kaplan-Meier analysis. Univariate and Multivariate Cox Proportional Hazards (PH) regression was performed as well. Results There was no difference in baseline clinical characteristics or hemodynamics before and after the policy change. Notably, there was a greater than 5-fold increase in ECMO utilization as a bridge to heart transplantation in the POST era. Distance from donor to recipient hospital (28 mi [7.0-271 mi] vs 261 mi [99-404 mi], p Conclusion Despite longer ischemic times and a greater distance between donor and recipient hospitals, six-month, post-transplant survival in patients bridged to heart transplant with ECMO improved after the UNOS policy change.