Outcomes of Status 4 Heart Transplant Candidates: A Nationwide Analysis
Presented During:
Friday, September 20, 2024: 5:00PM - 6:30PM
Omni King Edward Hotel
Abstract No:
10135
Submission Type:
Abstract Submission
Authors:
Craig Jarrett (1), Kelsey Gray (1), Yakov Elgudin (1), Chantal ElAmm (1), Marc Pelletier (1), Yasir Abu-Omar (1)
Institutions:
(1) University Hospitals, Cleveland, OH
Submitting Author:
Craig Jarrett
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University Hospitals
University Hospitals
Co-Author(s):
Kelsey Gray
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University Hospitals
University Hospitals
Yakov Elgudin
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University Hospitals
University Hospitals
Chantal ElAmm
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University Hospitals
University Hospitals
*Marc Pelletier
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University Hospitals
University Hospitals
*Yasir Abu-Omar
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University Hospitals
University Hospitals
Presenting Author:
Craig Jarrett
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University Hospitals of Cleveland
University Hospitals of Cleveland
Abstract:
Objective: UNOS status 4 represents a heterogeneous mix of pathologies including patients with inotrope dependence and durable LVADs. For better understanding during advanced heart failure discussions, we compared outcomes of status 4 patients by indication in a nationwide analysis.
Methods: We included all adults (age≥18) in the UNOS STAR file who were listed for heart transplant from 10/18/2018-3/30/2024 with any time as status 4 with the primary focus on patients initially listed as status 4. Primary endpoints were percent of patients and transplants, time to transplant, and survival on the waitlist stratified by indication. Survival was estimated using the Kaplan-Meier method and compared using the log-rank test.
Results: A total of 11,966 unique patients were listed as status 4 with 66.7% (7,983/11,966) as initial status 4. Most (96.3%, 7,687/7,983) initial status 4 patients had no change in the indication for status 4 while listed. Overall, 65.5% (5,232/7,983) of patients were transplanted with a median 70 days (IQR: 24-194) to transplant. For initial status 4 patients, 19.9% were transplanted at 1 month, 38.1% at 3 months, 50.1% at 6 months, 61.8% at 12 months, 67.5% at 18 months, 71.1% at 24 months, 75.0% at 36 months, 77.3% at 48 months, and 77.9% at 60 months (Figure). Percent of total patients, percent of total transplants, and median days to transplant by indication were: 38.8% (3,098/7,983), 33.3% (1,741/5,232), and 135 for LVAD; 20.0% (1,598), 23.4% (1,223), and 31 for IV inotropes; 15.3% (1,218), 16.4% (860), and 60 for exceptions; 10.5% (837), 12.1% (635), and 57 for cardiomyopathy; 8.0% (636), 7.3% (381), and 105 for congenital heart disease; 5.4% (435), 5.4% (283), and 70 for re-transplant; and 2.0% (161), 2.1% (109), and 46 for ischemic heart disease, respectively. Median survival on the waitlist was: 48 months for LVAD, 47 for congenital heart disease, 40 for cardiomyopathy, 38 for ischemic heart disease, 33 for re-transplant, 31 for exceptions, and 24 for IV inotropes. At 5 years, waitlist survival was highest with LVAD indications, and lowest with re-transplant and inotrope dependent indications (p<0.0001).
Conclusions: For status 4 patients, half will be transplanted within 6 months and two-thirds will be transplanted within 18 months of initial status 4 listing. Waitlist survival for status 4 patients is heterogeneous with patients on LVADS having twice the median survival compared to patients on IV inotropes. These results should be considered in advanced heart failure shared decision making.
Figure Legend: Alluvial plot of 7,983 initial status 4 patients showing status changes, deaths on the waiting list, delistings, and transplants at specific time points. Flows of less than 20 patients are not shown for clarity. Dec denotes deceased; Del, delisted; and Tra, transplanted.
Methods: We included all adults (age≥18) in the UNOS STAR file who were listed for heart transplant from 10/18/2018-3/30/2024 with any time as status 4 with the primary focus on patients initially listed as status 4. Primary endpoints were percent of patients and transplants, time to transplant, and survival on the waitlist stratified by indication. Survival was estimated using the Kaplan-Meier method and compared using the log-rank test.
Results: A total of 11,966 unique patients were listed as status 4 with 66.7% (7,983/11,966) as initial status 4. Most (96.3%, 7,687/7,983) initial status 4 patients had no change in the indication for status 4 while listed. Overall, 65.5% (5,232/7,983) of patients were transplanted with a median 70 days (IQR: 24-194) to transplant. For initial status 4 patients, 19.9% were transplanted at 1 month, 38.1% at 3 months, 50.1% at 6 months, 61.8% at 12 months, 67.5% at 18 months, 71.1% at 24 months, 75.0% at 36 months, 77.3% at 48 months, and 77.9% at 60 months (Figure). Percent of total patients, percent of total transplants, and median days to transplant by indication were: 38.8% (3,098/7,983), 33.3% (1,741/5,232), and 135 for LVAD; 20.0% (1,598), 23.4% (1,223), and 31 for IV inotropes; 15.3% (1,218), 16.4% (860), and 60 for exceptions; 10.5% (837), 12.1% (635), and 57 for cardiomyopathy; 8.0% (636), 7.3% (381), and 105 for congenital heart disease; 5.4% (435), 5.4% (283), and 70 for re-transplant; and 2.0% (161), 2.1% (109), and 46 for ischemic heart disease, respectively. Median survival on the waitlist was: 48 months for LVAD, 47 for congenital heart disease, 40 for cardiomyopathy, 38 for ischemic heart disease, 33 for re-transplant, 31 for exceptions, and 24 for IV inotropes. At 5 years, waitlist survival was highest with LVAD indications, and lowest with re-transplant and inotrope dependent indications (p<0.0001).
Conclusions: For status 4 patients, half will be transplanted within 6 months and two-thirds will be transplanted within 18 months of initial status 4 listing. Waitlist survival for status 4 patients is heterogeneous with patients on LVADS having twice the median survival compared to patients on IV inotropes. These results should be considered in advanced heart failure shared decision making.
Figure Legend: Alluvial plot of 7,983 initial status 4 patients showing status changes, deaths on the waiting list, delistings, and transplants at specific time points. Flows of less than 20 patients are not shown for clarity. Dec denotes deceased; Del, delisted; and Tra, transplanted.
Mechanical Support and Thoracic Transplantation Summit:
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