Prolonged waitlisting is associated with mortality in extracorporeal membrane oxygenation-supported heart transplantation candidates

Taylor Nordan; Andre C Critsinelis; Amanda Vest; Yijing Zhang; Frederick Y Chen; Gregory S Couper; Masashi Kawabori

doi:10.1016/j.xjon.2022.09.010

Prolonged waitlisting is associated with mortality in extracorporeal membrane oxygenation-supported heart transplantation candidates

JTCVS Open. 2022 Oct 5:12:234-254. doi: 10.1016/j.xjon.2022.09.010. eCollection 2022 Dec.

Authors

Taylor Nordan¹, Andre C Critsinelis², Amanda Vest³, Yijing Zhang³, Frederick Y Chen¹, Gregory S Couper¹, Masashi Kawabori¹

Affiliations

¹ Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass.
² Department of Surgery, Mount Sinai Medical Center, Miami Beach, Fla.
³ Division of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, Mass.

Abstract

Objective: Heart transplantation (HTx) candidates supported with venoarterial extracorporeal membrane oxygenation (ECMO) may be listed at highest status 1 but are at inherent risk for ECMO-related complications. The effect of waitlist time on postlisting survival remains unclear in candidates with ECMO support who are listed using the new allocation system.

Methods: Adult candidates listed with ECMO for a first-time, single-organ HTx from October 18, 2018, to March 21, 2021, in the Scientific Registry of Transplant Recipients database were included and stratified according to waitlist time (≤7 vs ≥8 days). Postlisting outcomes were compared between cohorts.

Results: Among 175 candidates waitlisted for ≤7 days, 162 (92.6%) underwent HTx whereas 13 (7.4%) died/deteriorated compared with 41 (57.8%) and 21 (29.6%) of the 71 candidates waitlisted for ≥8 days, respectively (P < .01). Blood type O candidates (odds ratio [OR], 2.94; 95% CI, 1.54-5.61) were more likely to wait ≥8 days whereas candidates with concurrent intra-aortic balloon pump were less likely (OR, 0.30; 95% CI, 0.10-0.89). Obesity was additionally associated among those listed at status 1 (OR, 2.04; 95% CI, 1.00-4.17). Waitlisting for ≥8 days was independently associated with 90-day postlisting mortality conditional on survival to day 8 postlisting (hazard ratio, 5.59; 95% CI, 2.59-12.1). Candidates listed at status 1 showed similar trends (hazard ratio, 5.49; 95% CI, 2.39-12.6). There was no significant difference in 90-day post-HTx survival depending on whether a candidate waited for ≥8 days versus ≤7 days (92.7 vs 92.0%; log rank P = .87).

Conclusions: Among ECMO-supported candidates, obtaining HTx within 1 week of listing might improve overall survival.

Keywords: BMI, body mass index; ECMO, extracorporeal membrane oxygenation; HR, hazard ratio; HTx, heart transplantation; IABP, intra-aortic balloon pump; IQR, interquartile range; LVAD, left ventricular assist device; OR, odds ratio; SRTR, Scientific Registry of Transplant Recipients; allocation system; heart transplantation; prolonged waitlisting.