Status 2 Upgrade Indication Impacts Post-Transplant Mortality in Patients Bridged with IABP in the New Heart Allocation System.

To evaluate outcomes of patients undergoing heart transplant (HT) using an intra-aortic balloon pump (IABP) under exception status. Adult patients supported with an IABP who underwent HT between 10/18/2018 and 12/31/2020 as documented in UNOS, were included. Patients were stratified according to request for exception status. Kaplan Meier methodology was used to look for differences in survival between groups. A total of 1284 patients were included, 492 (38.3%) were transplanted with an IABP under exception status. Exception status patients had higher BMI, were more likely to be Black, and to have longer waitlist time. Exception status patients received organs from younger donors, had a shorter ischemic time and a higher frequency of sex mismatch. The one-year post transplant survival was 93% for the non-exception and 88% for exception IABP patients (HR 1.85 (1.12-2.86, p =0.006). The most common cause for request of an exception status was inability to meet blood pressure criteria for extension (37% of patients). The most common reason for extension request of exception status was right ventricular dysfunction (24%). IABP patients transplanted under exception status have an increased one-year mortality post transplantation compared to those without exception status.

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