This study compared two registry data sources — the OPTN STAR MCS file and the SRTR MCS file — for estimating trends in durable LVAD use and waitlist outcomes among adult heart transplant candidates implanted with LVADs between October 18, 2018 and December 31, 2024.
The STAR MCS file alone showed a spurious 92.5% decline in LVAD prevalence (1,740 → 131 candidates), while the SRTR file showed stable prevalence (30.7%–37.4%). STAR-based analyses also inflated 3-year transplant incidence (66.7% vs. 54.4%) and death/deterioration (10.1% vs. 4.5%); combining STAR MCS with status justification files corrected both errors.
- Study is registry-based and descriptive; no causal inference possible. - Findings are specific to the post-October 2018 UNOS allocation policy era. - The correction method (adding status justification files) requires researcher awareness and extra data linkage steps not typically performed.
Researchers using STAR registry data to study LVAD trends must supplement the MCS file with status justification files — or use the SRTR MCS file instead — to avoid dramatically underestimating LVAD prevalence and producing inflated waitlist outcome estimates.
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