Association between listing hemodynamics and heart transplantation waitlist outcomes: An analysis of the Scientific Registry of Transplant Recipients.

BACKGROUND

The association between invasive hemodynamics measurements at time of listing for heart transplantation and the outcome of removal from the waitlist for death or deterioration was evaluated.

METHODS

Retrospective analysis of the Scientific Registry of Transplant Candidates, including all adults listed for heart transplant from October 2018 through December 2023 was completed. All patients with listing hemodynamics for statuses 1-4, and 6, were included, unless obtained while on mechanical circulatory support. Survival analyses was performed using competing risks regressions to assess the association between baseline hemodynamic parameters and 30-day and one-year outcomes. Results reported as sub-hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS

A total of 22,396 patients were listed for heart transplant, of which 14,079 patients met inclusion criteria. Aortic pulsatility index (API) < 1.45 (subHR 2.14 95%CI 1.64,2.79 p<0.001), left ventricular stroke work index (LVSWI) < 20 (subHR 2.37 95%CI 1.77,3.19 p <0.001), myocardial performance score (MPS) < 0.5 (subHR 2.15 95%CI 1.64,2.81 p<0.001), pulmonary capillary wedge pressure (PCWP) > 15 mmHg (subHR 2.15 95%CI 1.67,2.85 p<0.001), and systolic blood pressure (SBP) < 90 mmHg (subHR 2.19 95%CI 1.67,2.85 p<0.001) had the strongest association with the primary outcome. As continuous metrics, API and MPS were most strongly associated with the primary outcome.

CONCLUSIONS

API, LVSWI, MPS, PCWP, and SBP were the strongest predictors of transplant waitlist removal for death or deterioration of patients. The current heart transplant allocation system could be improved by incorporating more prognostic hemodynamic criteria for waitlist risk stratification.