- Resource Type:
- Presentation
142. Caution for Blood Type O Candidates: Increased Waitlist Time on VA-ECMO Decreases Survival to Heart Transplantation
May 16, 2022
Leora Yarboro , Invited Discussant , University of Virginia
Masashi Kawabori , Abstract Presenter , Tufts medical center
102nd Annual Meeting, Boston, MA, USA
Hynes Convention Center, Room 302
Abstract
Objective: Venoarterial extracorporeal membrane oxygenation (ECMO) support provides listing at status 1 for heart transplant (HTx) under the new allocation system. However, prolonged ECMO support may cause complications. We sought to determine the 1) association between waitlist days and reason for waitlist removal and 2) independent predictors of prolonged ECMO support defined as ≥8 days.
Methods: The UNOS database was queried for adult ECMO-supported HTx candidates listed for a primary single-organ HTx between October 18, 2018 and March 31, 2021. Candidates were dichotomized based on waitlist time with analysis of delisting reasons at each day within 7 days. A further analysis was performed in which candidates were dichotomized based waitlist time above or below 7 days with reasons for delisting compared as candidates must be reverified each week. Baseline recipient characteristics were entered into a multivariable logistic regression model to determine independent predictors of waitlist removal ≥8 days.
Results: 243 candidates were included. As waitlist time increased, the proportion of delisting due to death or clinical deterioration increased from 33/224 (14.7%) (≥2 days) to 22/78 (28.2%) (≥7 days). Concurrently, the proportion of HTx decreased from 184/224 (82.1%) (≥2 days) to 49/78 (62.8%) (≥7 days). Of candidates waitlisted for ≥8 days, 40/68 (58.8%) survived to HTx while 21/68 (30.9%) were removed due to death or clinical deterioration (Figure A). On multivariable analysis, blood type O (aOR 2.34, 95% CI 1.22–4.46) was associated with an increased likelihood of waitlisting ≥8 days, while older age (aOR 0.97 per year, 95% CI 0.95–0.998) and concomitant IABP support (aOR 0.33, 95% CI 0.11–0.95) were protective (Figure B).
Conclusion: As waitlist time increases, delisting due to death or clinical deterioration increases and survival to HTx decreases. Blood type O is independently associated with waitlisting for more than 1 week. Since blood type is non-modifiable, blood type O candidates may require prioritization or alternative bridging strategies.
Masashi Kawabori (1), Taylor Nordan (1), Jamel Ortoleva MD (1), Andre Critsinelis (2), Frederick Chen (1), Gregory Couper (1), (1) Tufts Medical Center, Boston, MA, (2) Mount Sinai Medical Center, Miami, FL
Leora Yarboro
Invited Discussant
Leora Yarboro is an associate professor of surgery at the University of Virginia. She is the surgical director of heart transplantation and mechanical circulatory support. She is certified by both the American Board of Thoracic Surgery and the American Board of Surgery.
Masashi Kawabori
Abstract Presenter
Masashi Kawabori MD
Assistant professor of surgery, Tufts university, School of medicine.
Cardiac surgeon, Research director, Tufts medical center, Boston MA.
I am interest in all aspects of adult heart failure cardiac surgery including heart transplantation, left ventricular assist devices, as well as wide variety of mechanical circulatory support devices. I am heavily involved with research and innovation including Impella left ventricular assist device which I serve as Impella 5.5 surgical consultant. I have authored over 80 peer reviewed papers and numerous book chapters. In addition to my clinical practice, I will continue translational and outcomes research at Tufts Medical Center.