Exception Use On Heart Transplantation Due To Cardiac Amyloidosis. A OPTN Database Analysis

Purpose The new heart transplant (HT) allocation system provides detailed criteria for prioritization of listing status for patients with cardiac amyloidosis. An increased use of exception status has been described in the new HT system. The objective of our study was to describe the clinical characteristics and post-transplant outcomes of patients with cardiac amyloidosis according to the request of exception status. Methods Adult patients who were listed and received a HT due to cardiac amyloidosis between October 18, 2018, and December 31, 2020, were included in this study. Patients were stratified according to the request of an exception status at the time of HT. Clinical characteristics at the time of transplant and post-transplant outcomes were compared between groups. The exceptions status narratives were reviewed to determine the adherence to the pre-specified criteria.* Results A total of 107 cardiac amyloid patients received HT during the study period. Of these, 47 (43.9%) had an exception status at the time of HT. Patient and donor characteristics were similar between groups (table). Most exception patients were transplanted at status 2 (n=33), most of which were supported by IABP (n=22). Of the patients transplanted with an exception status 31 were ATTR,13 were AL amyloid, and 3 were non-specified. Eighteen (38.2%) patients who were transplanted as an exception status did not meet the pre-specified criteria developed for amyloidosis. Arrhythmias and not meeting hypotension parameters were the most common cause for the request of Ad Hoc exception requests. The one-year survival post-transplantation was similar between exception and non-exception groups (93.3% vs. 95.7%, p=0.65). Conclusion A large proportion of cardiac amyloid patients are transplanted utilizing an exception status. One third of these patients do not meet the pre-specified criteria for exception status and require Ad Hoc exception request. Exception status is not associated with changes in one-year post-transplant survival. The new heart transplant (HT) allocation system provides detailed criteria for prioritization of listing status for patients with cardiac amyloidosis. An increased use of exception status has been described in the new HT system. The objective of our study was to describe the clinical characteristics and post-transplant outcomes of patients with cardiac amyloidosis according to the request of exception status. Adult patients who were listed and received a HT due to cardiac amyloidosis between October 18, 2018, and December 31, 2020, were included in this study. Patients were stratified according to the request of an exception status at the time of HT. Clinical characteristics at the time of transplant and post-transplant outcomes were compared between groups. The exceptions status narratives were reviewed to determine the adherence to the pre-specified criteria.* A total of 107 cardiac amyloid patients received HT during the study period. Of these, 47 (43.9%) had an exception status at the time of HT. Patient and donor characteristics were similar between groups (table). Most exception patients were transplanted at status 2 (n=33), most of which were supported by IABP (n=22). Of the patients transplanted with an exception status 31 were ATTR,13 were AL amyloid, and 3 were non-specified. Eighteen (38.2%) patients who were transplanted as an exception status did not meet the pre-specified criteria developed for amyloidosis. Arrhythmias and not meeting hypotension parameters were the most common cause for the request of Ad Hoc exception requests. The one-year survival post-transplantation was similar between exception and non-exception groups (93.3% vs. 95.7%, p=0.65). A large proportion of cardiac amyloid patients are transplanted utilizing an exception status. One third of these patients do not meet the pre-specified criteria for exception status and require Ad Hoc exception request. Exception status is not associated with changes in one-year post-transplant survival.