Assistant Professor University of Louisville Louisville, Kentucky, United States
Disclosure(s):
Erin Schumer, MD, MPH: No financial relationships to disclose
If you selected other, please specify:: Heart transplant and mechanical circulatory support
Purpose: The 2018 heart transplant allocation policy dramatically changed the profile of heart transplant recipients to increased acute mechanical circulatory support and decreased durable left ventricular assist devices. We examined regional patterns of extracorporeal membrane oxygenation (ECMO) use pre- and post-allocation change.
Methods: Using the United Network for Organ Sharing database, we identified adult patients who underwent heart transplant with available data from January, 2006 - June, 2022. The study time period was divided into pre- (January 2006 - October 17, 2018) and post- (October 18, 2018 - June, 2022) allocation change. We divided ECMO patients by region and used linear regression to analyze change in the rate of ECMO use by region between the two eras. Chi-square analysis and t-test were used to compare differences between groups. Kaplan-Meier survival with log-rank analysis was used to determine post-transplant survival differences. A p-value of 0.05 was considered significant.
Results: A total of 41,636 heart transplant recipients were found, of which 891 (2.1%) were on ECMO at the time of transplant. Overall ECMO use increased from 231 (0.8%) to 660 (5.5%) between eras (p < 0.001). There was significant regional variation in the rate of ECMO usage shown in Figure 1 (p < 0.001), with regions 1, 6, 9 having the greatest increase between eras. There were significant differences in postoperative dialysis (p=0.014) and acute rejection episodes (p < 0.001), but no significant difference in pacemaker rate (p=0.172), stroke (p=0.212), or treatment for rejection within 1 year (p=0.358) between regions (Table 1). There was no significant difference in post-transplant survival in the current era between regions for patients on ECMO at the time of heart transplant (p=0.444).
Conclusion: The increased utilization of ECMO following implementation of an allocation system which prioritizes ECMO recipients on the waitlist and the differential use of ECMO in various regions questions if factors other than clinical need contributed to the higher use of ECMO as bridge to heart transplant in the current era.
Identify the source of the funding for this research project : There was no funding.
