Long-Term Outcome of Heart Transplant Recipients with Acute Graft Dysfunction Requiring Temporary Mechanical Circulatory Support

Abstract

Mechanical circulatory support for acute graft dysfunction in heart transplant recipients is associated with increased early mortality and morbidity. Long-term outcome in patients who are successfully discharged from hospital is less well known. We performed a retrospective review of results in all adult patients (age > 18) who received first time heart transplant at our institution between 2007 and 2017. We compared graft survival and freedom from acute cellular and antibody mediated rejection of 90-day survivors who required mechanical support for graft failure with those who did not. We performed 243 first time adult heart transplantations over the study period with 6% 90-day mortality and 68±5% 5-year patient survival. (62±5% graft survival with 4 patients necessitating re-transplantation for severe CAV). Short-term outcome of patients supported with various types of MCS is depicted in Table 1. Five-year graft survival, freedom from ACR and freedom from AMR was 87±3%, 82±3% and 92±2% in patients without the need for post-transplant MCS and 53±15%, 49±17% and 75±13% in patients requiring MCS (Figure 1). Heart transplant recipients who require post-operative mechanical support and survive 90 days experience decreased long-term survival and less freedom from both acute cellular and antibody mediated rejection.