Association between Continuous Flow Left Ventricular Assist Device Infections Requiring Long-Term Antibiotic Use and Post Heart Transplant Morbidity and Mortality

Abstract

PurposeInfections in patients with a left ventricular assist device (LVAD) for bridge to heart transplant (HTx) do not appear to impact post-HTx survival. We evaluated the association between LVAD-related infections requiring long-term suppressive antibiotics and non-recent infections of any kind on the risk of early and late infection, rejection and mortality post-HTx in comparison to LVAD recipients without infection.MethodsThis is a single-center retrospective observational cohort study of consecutive adults with a durable continuous flow LVAD undergoing HTx between 2006-2019. Patients were grouped into: 1) LVAD-related infection requiring long-term antibiotic use until time of HTx; 2) any type of infection after LVAD implant in whom antibiotics were stopped at least 1 month prior to HTx; and 3) no infections between LVAD implant and HTx. LVAD-related infections included bacteremia, driveline or pocket. We evaluated the association between LVAD infection and post-HTx in-hospital infection, rejection and mortality using logistic regression, and long-term infection, rejection and mortality using Cox PH models.ResultsWe included 75 LVAD recipients; 16 (21%) patients had an LVAD-related infection on suppressive antibiotics, 30 (40%) had a non-recent infection, and 29 (39%) had no infections. During a median post-HTx follow-up time of 4 (2-7) years, we observed 65/75 (87%) infections, 43/67 (64%) rejections, and 17/75 (23%) deaths. Both short- and long-term risk of infection, rejection, and mortality did not differ significantly among the groups (Table 1).ConclusionLVAD patients with history of infections did not have higher risk of infection, rejection or mortality at any time point after HTx. Different post-HTx management strategies may have buffered the risk of adverse events in LVAD patients with infections. Infections in patients with a left ventricular assist device (LVAD) for bridge to heart transplant (HTx) do not appear to impact post-HTx survival. We evaluated the association between LVAD-related infections requiring long-term suppressive antibiotics and non-recent infections of any kind on the risk of early and late infection, rejection and mortality post-HTx in comparison to LVAD recipients without infection. This is a single-center retrospective observational cohort study of consecutive adults with a durable continuous flow LVAD undergoing HTx between 2006-2019. Patients were grouped into: 1) LVAD-related infection requiring long-term antibiotic use until time of HTx; 2) any type of infection after LVAD implant in whom antibiotics were stopped at least 1 month prior to HTx; and 3) no infections between LVAD implant and HTx. LVAD-related infections included bacteremia, driveline or pocket. We evaluated the association between LVAD infection and post-HTx in-hospital infection, rejection and mortality using logistic regression, and long-term infection, rejection and mortality using Cox PH models. We included 75 LVAD recipients; 16 (21%) patients had an LVAD-related infection on suppressive antibiotics, 30 (40%) had a non-recent infection, and 29 (39%) had no infections. During a median post-HTx follow-up time of 4 (2-7) years, we observed 65/75 (87%) infections, 43/67 (64%) rejections, and 17/75 (23%) deaths. Both short- and long-term risk of infection, rejection, and mortality did not differ significantly among the groups (Table 1). LVAD patients with history of infections did not have higher risk of infection, rejection or mortality at any time point after HTx. Different post-HTx management strategies may have buffered the risk of adverse events in LVAD patients with infections.