Key result
Durable LVAD waitlist candidates face a ~42% cumulative incidence of complications or status upgrades at 6 years.
Why the study?
Does the OPTN status escalation policy impact the status distribution of the waitlist for adult heart transplant candidates with durable LVADs?
Cohort (n=4,967)
Yes
Does the OPTN status escalation policy impact the status distribution of the waitlist for adult heart transplant candidates with durable LVADs?
Answers are grounded in this paper and cite their sources.
The upcoming OPTN policy granting status upgrades at 6 and 8 years post-LVAD is unlikely to prevent device complications, as almost all candidates experience complications, are transplanted, or are removed from the waitlist before 6 years.
BACKGROUND: The 2018 heart allocation policy change substantially lowered the priority of candidates supported with durable left ventricular assist devices (LVADs) for heart transplantation. To provide stable candidates supported by durable LVADs with a quicker path to transplantation before they suffer complications, the Organ Procurement and Transplantation Network (OPTN) approved a policy stipulating that stable patients supported by durable LVADs for 6 and 8 years will obtain statuses 3 and 2, respectively. METHODS: Using OPTN data, we identified all adult heart transplant candidates with a durable LVAD implanted between October 18, 2018 and May 31, 2025. We estimated the cumulative incidence of LVAD-related complications, treating transplantation and waitlist removal before experiencing complications as competing events. Furthermore, we assessed how the OPTN policy change would impact the status distribution of the waitlist. RESULTS: In our study cohort, 4967 adult patients who were listed for heart transplant received a durable LVAD. Transplant centers submitted 2879 justifications for status upgrades due to LVAD-related complications for 1812 (36.5%) patients. At 6 years after durable LVAD implantation, the cumulative incidence of complications and status upgrades was 42.1% (95% CI, 40.5%–43.8%), and that of transplantation was 36.0% (95% CI, 34.6%–37.6%). Of the 3779 patients who were not censored administratively, only 47 (1.2%) remained on the waitlist by 6 years after durable LVAD implantation. Had the 6- to 8-year OPTN policy change been implemented on June 1, 2025, only 4.7% of the waitlist would have changed statuses instantaneously. CONCLUSIONS: Almost all listed candidates with durable LVADs either experience a complication, status upgrade or are removed from the waitlist within 6 years of obtaining a durable LVAD. The upcoming OPTN policy is unlikely to prevent device complications before granting status upgrades and will likely impact a small percentage of candidates with durable LVADs.
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Ahn et al. (2026) conducted a cohort in Adult heart transplant candidates with durable LVADs (n=4,967). Durable LVAD support was evaluated on Cumulative incidence of LVAD-related complications and status upgrades (95% CI 40.5-43.8). Durable LVAD support in adult heart transplant candidates was associated with a 42.1% (95% CI, 40.5%-43.8%) cumulative incidence of complications and status upgrades at 6 years.
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