Are Redo Heart Transplant Patients Appropriately Listed as Status 4 on the Waitlist

Purpose: The new donor heart allocation policy change occurred in October 2018. At that time, the waiting list statuses changed from 3 statuses to 6 statuses. In the old donor heart policy, Redo heart transplants (HTx) were listed as stable patients waiting at home, which were usually status 2 (old policy). After 2018, redo heart transplants are now status 4 which is a higher listing status compared to the old policy. Redo HTx patients may have higher mortality due to the fact that many have sudden death due to pulseless electrical activity arrest. It has not been established whether waitlist mortality for redo HTx as status 4 patients on the waitlist is greater than other status 4 patients. We wish to establish this waitlist mortality rate in terms of perhaps higher priority listing for these patients.Methods: Between October 18, 2018, and December 31, 2021, we assessed 33 redo HTx patients who were accepted onto the HTx waiting list in our program. These redo HTx patients were compared to 89 non-redo HTx patients listed as Status 4 at our institution. All patients were assessed for 1-year survival on the waitlist and the percentage of patients upgraded to a higher status due to worsening heart failure.Results: Redo heart transplant patients listed at Status 4 compared to non-redo heart transplant patients had no significant difference for time on the waitlist, time to transplant, percent transplanted and 1-year waitlist survival. The percent of patients switched to a higher status was similar between groups (72.7% vs 68.5%). For this subgroup of patient, there was no difference for the same waitlist outcomes as above. (see table)Conclusion: Waitlist status 4 for redo heart transplant patients on the heart transplant waitlist appears appropriate. More urgent listing is not indicated for these patients. : The new donor heart allocation policy change occurred in October 2018. At that time, the waiting list statuses changed from 3 statuses to 6 statuses. In the old donor heart policy, Redo heart transplants (HTx) were listed as stable patients waiting at home, which were usually status 2 (old policy). After 2018, redo heart transplants are now status 4 which is a higher listing status compared to the old policy. Redo HTx patients may have higher mortality due to the fact that many have sudden death due to pulseless electrical activity arrest. It has not been established whether waitlist mortality for redo HTx as status 4 patients on the waitlist is greater than other status 4 patients. We wish to establish this waitlist mortality rate in terms of perhaps higher priority listing for these patients. : Between October 18, 2018, and December 31, 2021, we assessed 33 redo HTx patients who were accepted onto the HTx waiting list in our program. These redo HTx patients were compared to 89 non-redo HTx patients listed as Status 4 at our institution. All patients were assessed for 1-year survival on the waitlist and the percentage of patients upgraded to a higher status due to worsening heart failure. : Redo heart transplant patients listed at Status 4 compared to non-redo heart transplant patients had no significant difference for time on the waitlist, time to transplant, percent transplanted and 1-year waitlist survival. The percent of patients switched to a higher status was similar between groups (72.7% vs 68.5%). For this subgroup of patient, there was no difference for the same waitlist outcomes as above. (see table) : Waitlist status 4 for redo heart transplant patients on the heart transplant waitlist appears appropriate. More urgent listing is not indicated for these patients.