Is Increased Utilization of Intra-Aortic Balloon Pump Support in Heart Transplant Recipients after OPTN Allocation Policy Change Warranted?

Purpose The OPTN allocation for hearts was changed in 2018 to improve equitable allocation of organs. This included higher priority for patients with pre-defined hemodynamic parameters requiring intra-aortic balloon (IABP) support. We sought to investigate if recent IABP use reflected historical patterns of patient acuity. Methods The UNOS database was queried for all adult heart transplants from January 1, 2010 to October 17, 2018 and October 18, 2018 through August 31, 2020. All patients with mechanical circulatory support outside of IABP were excluded. Baseline features and short-term outcomes were reviewed. Body surface area was estimated using the Boyd method and used to calculate cardiac index. Thirty day survival was analyzed using the Kaplan-Meier method. Results In total, 9478 patients were identified prior to the policy, with 1081 (11.4%) on IABP support at transplant. In contrast, 2686 patients were available after the policy change, with 1221 on IABP support (45.5%; p Conclusion IABP support has rapidly become more common among heart transplant recipients after the OPTN heart allocation policy change. Status upgrade does not appear to be substantiated by IABP use when compared to pre-policy IABP cohort.