Results:

A total of 1,797 patients had LVAD at the time of transplant; 983 candidates were listed prior to the policy change and 814 listed after the policy change. The number of LVADs present at the time of listing declined from 102 in April 2017 to 12 in April 2020. The number of LVADs implanted after listing also decreased, from 21 to 0. Aside from a slight increase in body mass index (BMI), baseline characteristics were similar between both cohorts. Prior to the policy change, most candidates (61.7%) were status 1B at the time of listing and status 1A (75.8%) at the time of transplant; under the new policy, most candidates were status 4 (55.9%) at the time of listing and status 3 (47.4%) at the time of transplant. Ischemic time (3.1 hours vs. 3.4 hours) and distance traveled (82 miles vs. 199 miles) were significantly higher post-policy change. There was no significant difference in waitlist survival between the two cohorts; however, donors were more likely to be high risk or be hepatitis C positive following the policy change. One-year post-transplant survival was significantly worse in the post-policy cohort (83.4% vs. 91.7%, p < 0.001). On multivariate Cox analysis, transplantation in the post-policy period was independently associated with worse post-transplant survival (hazard ratio, 2.0; 95% confidence interval, 1.4-2.9; p < 0.001).