Comparison of Patients Undergoing Multiorgan Transplantation with or without Prior Ventricular Assist Device

Abstract

Purpose Both multiorgan transplantation and ventricular assist devices (VAD) pose significant challenges including sensitization, immunosuppressive treatment, and infrastructure demands. Despite these challenges, we hypothesized that the recipients of multiorgan transplants with and without VADs would have equivalent survival. We compared the survival of multiorgan transplant recipients with and without prior VAD placement. Methods We retrospectively analyzed all patients who underwent heart-kidney and heart-liver transplants at Stanford University from January 1993 to December 2017. The multiorgan transplant recipients were divided into two cohorts: those patients who had a VAD prior to transplantation and those who did not have a VAD prior to transplantation. Demographic data was collected and survival analysis was performed. Results During the study period, 53 patients underwent either heart-kidney (45) or heart-liver (8) transplantation. Eleven multiorgan recipients had a VAD prior to transplantation and 42 multiorgan recipients did not have a VAD prior to transplantation. Multiorgan transplant recipients who underwent prior VAD placement had a higher weight (p=0.01), compared to multiorgan transplant recipients without VAD placement. Otherwise, there were no significant differences in age (p=0.3), body mass index (p=0.43), waitlist time (p=0.3), allograft ischemic time (p=0.64), hospital stay (p=0.9), donor age (p=0.49), or donor cardiac ejection fraction (p=0.57). Using Kaplan-Meier Survival Analysis, the overall survival was similar in the VAD to multiorgan transplantation cohort as compared to the multiorgan transplantation cohort without VAD (log rank p=0.5343). Conclusion We demonstrated that patients undergoing multiorgan transplantation after VAD placement have similar survival to those patients who underwent multiorgan transplantation without previous VAD placement.