Impact of long term left ventricular assist device therapy on donor allocation in cardiac transplantation

Nir Uriel, Ulrich P. Jorde, Sang Woo Pak, Jeff Jiang, Kevin Clerkin, Hiroo Takayama, Yoshifumi Naka, P. Christian Schulze, Donna M. Mancini

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: Left Ventricular Assist Devices (LVAD) are increasingly used as a bridge to transplant (BTT) for patients with advanced congestive heart failure (CHF) and are assigned United Network for Organ Sharing (UNOS) high priority status (1B or 1A). Methods: The purpose of our study was asses the effect of organ allocation in the era of continuous flow pumps. A retrospective chart review was performed of all patients transplanted between 1/2001-1/2011 at Columbia University Medical Center. Results: Seven hundred twenty six adult heart transplantations were performed. Two hundred seventy four BTT patients were implanted with LVAD; of which 227 patients were transplanted. Sixty three patients were transplanted as UNOS-1B, while 164 were transplanted as UNOS-1A (72%). Of these 164 patients, 65 were transplanted during their 30-day 1A period (43%) and 96 after upgrading to UNOS-1A for device complication (56%). For 452 non-device patients 139 (31%) were transplanted as UNOS-1A, 233 as UNOS-1B (52%), and 80 as UNOS-2 (17%). The percentage of patients bridged with LVAD increased from 19% in 2001 to 64% in 2010 while the number transplanted during their 30 day 1A grace period declined from 57% in 2005 to 16% in 2011; i.e. 84% of BTT patients in 2011 needed more than 30 days 1A time to be transplanted. Most LVAD patients are now transplanted while suffering device complication. There was no difference in post transplant survival between LVAD patients transplanted as UNOS 1B, 1A grace period or for a device complication Conclusions: As wait time for cardiac transplantation increased the percentage of patients being bridged to transplant with an LVAD has increased with the majority of them transplanted in the setting of device complication.

Original languageEnglish (US)
Pages (from-to)188-195
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume32
Issue number2
DOIs
StatePublished - Feb 2013
Externally publishedYes

Fingerprint

Heart-Assist Devices
Heart Transplantation
Tissue Donors
Transplants
Therapeutics
Equipment and Supplies
Equidae
Heart Failure

Keywords

  • cardiac donor
  • heart transplantation
  • left ventricular assist device (LVAD)
  • organ allocation
  • UNOS classification

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Impact of long term left ventricular assist device therapy on donor allocation in cardiac transplantation. / Uriel, Nir; Jorde, Ulrich P.; Woo Pak, Sang; Jiang, Jeff; Clerkin, Kevin; Takayama, Hiroo; Naka, Yoshifumi; Christian Schulze, P.; Mancini, Donna M.

In: Journal of Heart and Lung Transplantation, Vol. 32, No. 2, 02.2013, p. 188-195.

Research output: Contribution to journalArticle

Uriel, N, Jorde, UP, Woo Pak, S, Jiang, J, Clerkin, K, Takayama, H, Naka, Y, Christian Schulze, P & Mancini, DM 2013, 'Impact of long term left ventricular assist device therapy on donor allocation in cardiac transplantation', Journal of Heart and Lung Transplantation, vol. 32, no. 2, pp. 188-195. https://doi.org/10.1016/j.healun.2012.11.010
Uriel, Nir ; Jorde, Ulrich P. ; Woo Pak, Sang ; Jiang, Jeff ; Clerkin, Kevin ; Takayama, Hiroo ; Naka, Yoshifumi ; Christian Schulze, P. ; Mancini, Donna M. / Impact of long term left ventricular assist device therapy on donor allocation in cardiac transplantation. In: Journal of Heart and Lung Transplantation. 2013 ; Vol. 32, No. 2. pp. 188-195.
@article{0100a5db29e247afa6d88ae38dcc36f8,
title = "Impact of long term left ventricular assist device therapy on donor allocation in cardiac transplantation",
abstract = "Background: Left Ventricular Assist Devices (LVAD) are increasingly used as a bridge to transplant (BTT) for patients with advanced congestive heart failure (CHF) and are assigned United Network for Organ Sharing (UNOS) high priority status (1B or 1A). Methods: The purpose of our study was asses the effect of organ allocation in the era of continuous flow pumps. A retrospective chart review was performed of all patients transplanted between 1/2001-1/2011 at Columbia University Medical Center. Results: Seven hundred twenty six adult heart transplantations were performed. Two hundred seventy four BTT patients were implanted with LVAD; of which 227 patients were transplanted. Sixty three patients were transplanted as UNOS-1B, while 164 were transplanted as UNOS-1A (72{\%}). Of these 164 patients, 65 were transplanted during their 30-day 1A period (43{\%}) and 96 after upgrading to UNOS-1A for device complication (56{\%}). For 452 non-device patients 139 (31{\%}) were transplanted as UNOS-1A, 233 as UNOS-1B (52{\%}), and 80 as UNOS-2 (17{\%}). The percentage of patients bridged with LVAD increased from 19{\%} in 2001 to 64{\%} in 2010 while the number transplanted during their 30 day 1A grace period declined from 57{\%} in 2005 to 16{\%} in 2011; i.e. 84{\%} of BTT patients in 2011 needed more than 30 days 1A time to be transplanted. Most LVAD patients are now transplanted while suffering device complication. There was no difference in post transplant survival between LVAD patients transplanted as UNOS 1B, 1A grace period or for a device complication Conclusions: As wait time for cardiac transplantation increased the percentage of patients being bridged to transplant with an LVAD has increased with the majority of them transplanted in the setting of device complication.",
keywords = "cardiac donor, heart transplantation, left ventricular assist device (LVAD), organ allocation, UNOS classification",
author = "Nir Uriel and Jorde, {Ulrich P.} and {Woo Pak}, Sang and Jeff Jiang and Kevin Clerkin and Hiroo Takayama and Yoshifumi Naka and {Christian Schulze}, P. and Mancini, {Donna M.}",
year = "2013",
month = "2",
doi = "10.1016/j.healun.2012.11.010",
language = "English (US)",
volume = "32",
pages = "188--195",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "2",

}

TY - JOUR

T1 - Impact of long term left ventricular assist device therapy on donor allocation in cardiac transplantation

AU - Uriel, Nir

AU - Jorde, Ulrich P.

AU - Woo Pak, Sang

AU - Jiang, Jeff

AU - Clerkin, Kevin

AU - Takayama, Hiroo

AU - Naka, Yoshifumi

AU - Christian Schulze, P.

AU - Mancini, Donna M.

PY - 2013/2

Y1 - 2013/2

N2 - Background: Left Ventricular Assist Devices (LVAD) are increasingly used as a bridge to transplant (BTT) for patients with advanced congestive heart failure (CHF) and are assigned United Network for Organ Sharing (UNOS) high priority status (1B or 1A). Methods: The purpose of our study was asses the effect of organ allocation in the era of continuous flow pumps. A retrospective chart review was performed of all patients transplanted between 1/2001-1/2011 at Columbia University Medical Center. Results: Seven hundred twenty six adult heart transplantations were performed. Two hundred seventy four BTT patients were implanted with LVAD; of which 227 patients were transplanted. Sixty three patients were transplanted as UNOS-1B, while 164 were transplanted as UNOS-1A (72%). Of these 164 patients, 65 were transplanted during their 30-day 1A period (43%) and 96 after upgrading to UNOS-1A for device complication (56%). For 452 non-device patients 139 (31%) were transplanted as UNOS-1A, 233 as UNOS-1B (52%), and 80 as UNOS-2 (17%). The percentage of patients bridged with LVAD increased from 19% in 2001 to 64% in 2010 while the number transplanted during their 30 day 1A grace period declined from 57% in 2005 to 16% in 2011; i.e. 84% of BTT patients in 2011 needed more than 30 days 1A time to be transplanted. Most LVAD patients are now transplanted while suffering device complication. There was no difference in post transplant survival between LVAD patients transplanted as UNOS 1B, 1A grace period or for a device complication Conclusions: As wait time for cardiac transplantation increased the percentage of patients being bridged to transplant with an LVAD has increased with the majority of them transplanted in the setting of device complication.

AB - Background: Left Ventricular Assist Devices (LVAD) are increasingly used as a bridge to transplant (BTT) for patients with advanced congestive heart failure (CHF) and are assigned United Network for Organ Sharing (UNOS) high priority status (1B or 1A). Methods: The purpose of our study was asses the effect of organ allocation in the era of continuous flow pumps. A retrospective chart review was performed of all patients transplanted between 1/2001-1/2011 at Columbia University Medical Center. Results: Seven hundred twenty six adult heart transplantations were performed. Two hundred seventy four BTT patients were implanted with LVAD; of which 227 patients were transplanted. Sixty three patients were transplanted as UNOS-1B, while 164 were transplanted as UNOS-1A (72%). Of these 164 patients, 65 were transplanted during their 30-day 1A period (43%) and 96 after upgrading to UNOS-1A for device complication (56%). For 452 non-device patients 139 (31%) were transplanted as UNOS-1A, 233 as UNOS-1B (52%), and 80 as UNOS-2 (17%). The percentage of patients bridged with LVAD increased from 19% in 2001 to 64% in 2010 while the number transplanted during their 30 day 1A grace period declined from 57% in 2005 to 16% in 2011; i.e. 84% of BTT patients in 2011 needed more than 30 days 1A time to be transplanted. Most LVAD patients are now transplanted while suffering device complication. There was no difference in post transplant survival between LVAD patients transplanted as UNOS 1B, 1A grace period or for a device complication Conclusions: As wait time for cardiac transplantation increased the percentage of patients being bridged to transplant with an LVAD has increased with the majority of them transplanted in the setting of device complication.

KW - cardiac donor

KW - heart transplantation

KW - left ventricular assist device (LVAD)

KW - organ allocation

KW - UNOS classification

UR - http://www.scopus.com/inward/record.url?scp=84872861790&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872861790&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2012.11.010

DO - 10.1016/j.healun.2012.11.010

M3 - Article

C2 - 23352392

AN - SCOPUS:84872861790

VL - 32

SP - 188

EP - 195

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 2

ER -