From the Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
Division of Cardiology, University of Louisville, Louisville, Kentucky.
ASAIO J. 2022 Jun 1;68(6):786-790. doi: 10.1097/MAT.0000000000001679. Epub 2022 Feb 16.
The new United Network for Organ Sharing (UNOS) policy has resulted in a significantly higher number of temporary mechanical circulatory support device usage such as extracorporeal membrane oxygenation, Impella, and intra-aortic balloon pump due to provision of higher priority with their use while on the waiting list. We aimed to identify Impella use in patients awaiting heart transplantation and temporal changes in its usage. The UNOS database was queried between years 2015 and 2019 for patients aged greater than or equal to 18 years, listed to undergo heart transplantation. A total of 378 patients had Impella support while listed for heart transplantation. Impella use skyrocketed from 2015 (1%) to 2019 (4%, p < 0.01). The most substantial increase in Impella use occurred after the UNOS policy change. The patients listed on Impella support after the policy change had significantly lower waiting time (median 12 days vs. 45 days, p < 0.01). More patients with Impella were directly transplanted (80% vs. 56%, p < 0.01) after the policy change, had significantly lower waitlist mortality (25% vs. 13%, p < 0.01) and fewer converted to a durable support (13% vs. 3%). The translatability (likelihood for receiving organs faster) was significantly improved after the policy change. A multivariable Cox regression model showed that post-transplant survival of Impella patients was not adversely affected after the policy change (hazard ratio = 0.9; p = 0.8). This increase in Impella use represents a substantial change in practice patterns of listing and managing patients on the heart transplant waiting list.
新的美国器官共享联合网络（UNOS）政策导致体外膜肺氧合、Impella 和主动脉内球囊泵等临时机械循环支持设备的使用数量显著增加，因为在等待名单上使用这些设备时提供了更高的优先级。我们旨在确定在等待心脏移植的患者中使用 Impella 的情况及其使用时间的变化。在 2015 年至 2019 年期间，我们在 UNOS 数据库中查询了年龄大于或等于 18 岁、列在接受心脏移植名单上的患者。共有 378 名患者在接受心脏移植时接受了 Impella 支持。Impella 的使用从 2015 年（1%）飙升至 2019 年（4%，p<0.01）。Impella 使用的大幅增加发生在 UNOS 政策变化之后。政策变化后，在 Impella 支持下被列入名单的患者等待时间明显缩短（中位数为 12 天对 45 天，p<0.01）。更多接受 Impella 治疗的患者在政策变化后直接接受移植（80%对 56%，p<0.01），等待名单死亡率显著降低（25%对 13%，p<0.01），转为永久性支持的患者减少（13%对 3%）。政策变化后，可移植性（更快获得器官的可能性）显著提高。多变量 Cox 回归模型显示，政策变化后，接受 Impella 治疗的患者移植后存活率未受不利影响（风险比=0.9；p=0.8）。Impella 使用的增加代表了在心脏移植等待名单上列出和管理患者的实践模式发生了重大变化。
