Do VAD Infections Predict Post-Heart Transplant Infections or Mortality?

Abstract

<h3>Purpose</h3> Infections are common after ventricular assist device (VAD) implantation but how these infections impact post-heart transplant (HT) course in patients (pts) supported with short-term (ST) VADs is not fully defined. We investigated whether VAD infections had any impact on post-HT outcomes, such as development of post-HT infections or mortality. <h3>Methods</h3> We performed a retrospective cohort study of 185 HT recipients (HTRs) supported with ST-VADs from 4/2006-10/2020. VAD-specific and -related infections were characterized according to 2011 ISHLT definitions. Statistics were performed using IBM® SPSS Statistics version 25.0. <h3>Results</h3> Prior to HT, 41 (22.2%) pts had VAD infections involving the bloodstream (n=17), pump (n=8), pocket (n=2) and driveline (n=22); gram-positive and -negative organisms were responsible for 55.3% and 44.7% of infections, respectively. Pts with VAD infections were predominantly male (68.2%, p=0.19), Caucasian (60.9 %, p=0.59), had non-ischemic cardiomyopathy (61%, p=0.67), and a mean age of 52.6 (p=0.351) at VAD implantation. Those with VAD infections had no significant difference in underlying lung disease (26.8% vs 22.9%, p=0.60), hypertension (41.5% vs 33.3%, p=0.33), diabetes mellitus (29.3% vs 21.5%, p=0.30), or chronic kidney disease (53.7% vs 62.5%, p=0.76). Pts with VAD infections had longer duration of VAD support (513.3 d vs. 290.7 d, p=0.001), but were similar to those without VAD infection in terms of HT hospitalization length of stay (26 d vs 24 d, p=0.28), need for re-operation (19.4% vs 16.7%, p=0.67), thymoglobulin induction (19.5% v. 21.5%, =0.78), cellular-rejection (12.2% vs 19.4%, p=0.29), and antibody-mediated rejection (31.7% vs 27.8%, p=0.62). HTRs with prior VAD infections had more post-HT infections, but this did not reach statistical significance (53.6% vs 43.1%, p=0.23), with more bacterial (43.9% v. 30.6%, p=0.11), fungal (14.6% vs 8.3%, p=0.23), and <i>C. difficile</i> (9.8% vs 3.5%, p=0.11) infections. In those with and without pre-HT VAD infections, 1-year all-cause mortality was 14.6% vs 6.9% (p=0.12), and 1-year infection-related mortality was 4.8% vs 3.5% (p=0.65). <h3>Conclusion</h3> In this single center study, there were non-significant increases in post-HT infections and mortality in HTRs with prior VAD infections. Larger studies are needed to further investigate the impact of VAD infections on post-HT outcomes.