Ventricular Assist Devices Are a Viable Method to Support Patients to Multi-Organ Transplant

Abstract

<h3>Purpose</h3> While ventricular assist devices (VADs) are known to improve survival in patients awaiting heart transplant, there are limited data describing the use of VADs in patients listed for multi-organ transplant or evaluating these patients' outcomes. <h3>Methods</h3> This retrospective cohort study identified patients from the UNOS database listed for heart transplant in combination with another solid organ from 2004-2019 and identified those with VADs at the time of listing and at transplant. Mortality was compared between patients with and without VAD using χ2 tests. Linear regression was used to assess changes in VAD use over time. <h3>Results</h3> Over 15 years, 22% (n=700) of heart-kidney (HK), 4% (n=20) of heart-liver (HLi), and 3% (n=25) of heart of heart-lung (HLu) patients were on VADs at listing. The median age of HK-VAD was 55y (IQR 47, 62), of HLi-VAD 52y (IQR 43, 55), and HLu-VAD 47y (IQR 33, 58). The majority of multi-organ VAD patients survived to transplant; 64% of HK-VAD, 70% of HLi-VAD, and 44% of HLu-VAD. Survival to transplant was higher in HK-VAD compared to HK-no VAD (72% vs 67%, p<0.05), while there was no difference between HLi-VAD and HLi-no VAD (80% vs 71%, p=0.38) or HLu-VAD and HLu-no VAD (52% vs 61%, p=0.37). One year post-transplant survival did not differ based on the presence of a VAD; HK-VAD (86.0%) vs HK-no VAD (88.9%) <i>p=0.11,</i> HLi-VAD (85.0%) vs HLi-no VAD (89.1%) <i>p=0.48</i>, and HLu-VAD (82.7%) vs HLu-no VAD (79.1%) <i>p=0.71.</i> <b>Figure</b> HK-VAD increased from 4 in 2004 to 94 in 2019 (<i>p for trend<0.001).</i> There were no changes over time in HLi-VAD or HLu-VAD <i>(p for both>0.05)</i>. <h3>Conclusion</h3> VADs are being used to support a substantial proportion of multi-organ patients, with an increase in patients waiting for heart-kidney transplant. The majority of these patients survive to transplant, and waitlist survival is higher in HK-VAD vs HK-no VAD. There is no difference in 1 year mortality when compared to patients without VADs, suggesting that this may be an effective support strategy for certain patients with multi-organ failure.