One but Not the Same: Risk Factors for Early Post-Transplant Mortality Differ between Medically Managed Patients and Those Bridged to Transplant with Left Ventricular Assist Devices

Abstract

Purpose Currently, criteria for heart transplant (HT) listing does not differ between patients medically managed versus mechanically bridged to HT. We evaluated differences in risk factors for 1-year mortality between those with and without LVAD at the time of HT. Methods In the UNOS database we identified adult, single-organ HT recipients transplanted between 2008 and 2015. 5486 patients were propensity matched for likelihood of LVAD at the time of HT. Cox proportional hazard regression analysis was used to evaluate the hazard ratio of 1-year mortality for patients BTT with LVAD as compared to medical management across thresholds of clinically significant variables. Results As compared to medically managed patients, those BTT with LVAD were at increased risk of 1-year post-HT mortality, with PGD being the most common cause of death. Compared to medically managed patients, BTT with LVAD was associated with increased risk of 1-year mortality at a eGFR of 40-60 mL/min/1.73m2 (HR 1.58, p=0.008) and a eGFR of 30 kg/m2 (HR: 1.93, p 60, eGFR 30kg/m2 there were significant differences in 1-year mortality between medium- and high-risk medically and mechanically bridged patients, with 17.6% 1-year mortality in high-risk BTT patients compared to 10.4% in high risk medically managed patients. Conclusion Patients bridged with mechanical support may require more careful consideration for transplant eligibility after LVAD placement in order to optimize post-HT outcomes. These findings should be taken into consideration when developing and/or refining heart systems.