LAUSR

BACKGROUND Intra-aortic balloon pumps (IABP) are used to bridge select end-stage heart disease patients to heart transplant (HT). IABP use and exception requests both increased dramatically after the UNOS policy change (PC). The purpose of this study was to evaluate the effect of PC and exception status requests on waitlist and post-transplant outcomes in patients bridged to HT with IABP support. METHODS We analyzed adult, first-time, single-organ HT recipients from the UNOS Registry either on IABP at the time of registration for HT or at the time of HT. We compared waitlist and post-HT outcomes between patients from the PRE (10/18/16 to 5/30/18) and POST (10/18/18 to 5/30/20) eras using Kaplan-Meier curves and time-to-event analyses. RESULTS 1267 patients underwent HT from IABP (261 pre-policy / 1006 post-policy). On multivariate analysis, PC was associated with an increase in HT (sub-distribution hazard ratio (sdHR): 2.15, p<0,001) and decrease in death/deterioration (sdHR: 0.55, p=0.011) on the waitlist with no effect on 1-year post-HT survival (p=0.8). Exception status of patients undergoing HT was predominantly seen in the POST era (29%, 293/1006); only 4 patients in the PRE era. Exception requests in the POST era did not alter patient outcomes. CONCLUSIONS In patients bridged to heart transplant with an IABP, policy change is associated with decreased rates of death/deterioration and increased rates of heart transplantation on the waitlist without affecting 1-year post-transplant survival. While exception status use has markedly increased post-PC, it is not associated with patient outcomes.