LVAD Patients with RV Failure Pre-Heart Transplant Have Reduced Post-Transplant Survival

Abstract

Purpose LVAD patients with right ventricular (RV) dysfunction are prioritized on the heart transplant waiting list, however the post-transplant survival of this group is less well characterized. We aimed to determine RV dysfunction effect on post-operative survival. Methods We performed a retrospective review of the 2005-2018 OPTN/UNOS registry for candidates ≥ 18 years of age waitlisted for first-time isolated heart transplantation post LVAD implantation. Candidates were stratified based upon having RV dysfunction defined as having liver dysfunction or by the need for RVAD or IV inotropes. Results 8,379 candidates met inclusion criteria including 978 LVAD BTT patients with RV dysfunction and 7,401 BTT patients without. Compared with non-RV dysfunction patients, LVAD BTT patients with RV dysfunction were younger (median age 53 vs 56, p 0.05). Pre-transplant liver dysfunction, however, was an independent predictor of worse survival (HR 1.56, 95% CI 1.30-1.86, p Conclusion Pre-heart transplant RV failure in LVAD BTT patients is associated with decreased post-transplant survival. This survival difference is driven primarily by pre-transplant liver failure likely reflecting increased severity of RV dysfunction. While these patients currently have priority in organ allocation, future studies should evaluate candidate optimization prior to organ acceptance to improve post-transplant outcomes, particularly among patients showing signs of liver failure