P58: Heart Transplantation Outcomes In Patients Bridged With Mechanical Circulatory Support Devices: Kazakhstan Experience

Abstract

Background: The management of end-stage heart failure (HF) with heart transplantation (HTx) as the gold standard therapy relies on a long-term mechanical circulatory support (MCS) devices for bridging patients. This study aimed to analyze clinical outcomes of HTx in bridge-to-transplant population in Kazakhstan. Methods: In this retrospective, single-center study we included 40 patients with MCS devices who were transplanted in Kazakhstan between 2014 and 2022. Results: Of the 85 transplantations performed, 40 (47%) were bridged with MCS including 31 (77,5%) with durable left ventricular assist devices (LVAD), 3 (7,5%) with total artificial heart (TAH), 2 (5 %) with fully implantable LVAD (FIVAD), 3 patients (7.5%) right ventricular plus LVAD, 1 (2.5%) with biventricular support device (Levitronix CentriMag). 25 (62.5%) HTx performed by using Organ Care System Transmedics due to large territory of Kazakhstan. Average age was 41,3 years (interquartile range, 17–64) and 4 patients (10%) were female. 26 patients (65%) with dilated cardiomyopathy. The most common complications on LVAD support before HTx were driveline infection (57.5%), arrhythmias (20%) and allosensitization (17.5%). Minimum waiting time was 15 days, maximum waiting time – 1999 days, average waiting time - 809±635 days. According to the Kaplan-Meier survival analysis unadjusted survival at 1 and 5 years posttransplant was 80 % and 67.5 %. For comparison, posttransplant survival of HF patients without LVAD was 80% and 57.7% respectively. Maximum life span after HTx was 7.8 years, median – 3.6 years. The most common causes of death in group of transplants bridged with MCS were multiorgan failure (n=6, 46.2%), infection/sepsis (n= 4, 30.7%) and acute graft rejection (n=1, 7.7%). In group of transplants without LVAD the most common causes of death were acute graft rejection (n=5, 22.7%), COVID-19 (n=4, 18.2%), kidney disease (n=4, 18.2%). Conclusion: Long waiting time in consequence of donor organ shortage in Kazakhstan and life-threatening complications on MCS device support are serious issue with particular significance in the bridge-to-transplant population. Despite these limiting factors, HTx in patients bridged with MCS demonstrated favorable survival outcomes similar in other published studies.