Outcome Of Heart Transplantation In Patients Research Articles

Heart Transplantation Outcomes in Patients With Hypertrophic Cardiomyopathy in the Era of Mechanical Circulatory Support.

Mechanical circulatory support has emerged as a vital therapeutic modality for patients awaiting heart transplantation (HT). However, it is unknown how it affected the characteristics and post-HT outcomes of patients with hypertrophic cardiomyopathy (HCM). This retrospective cohort study analyzed adult HT recipients from the International Society for Heart and Lung Transplantation registry (1998-2017). Two equal-duration eras were defined: era 1 1998-2007 and era 2 2008-2017. Patients with HCM were compared across the two eras (n1 = 742 and n2 = 1,211) and within each era, they were contrasted with individuals with nonischemic (NICM) (n1 = 15,964 and n2 = 20,394) and ischemic cardiomyopathy (ICM) (n1 = 14,140 and n2 = 12,986). Across eras, the number of HTs among patients with HCM increased by 63%. The rate of recipients with HCM in the intensive care unit (ICU) supported with intra-aortic balloon pump (IABP) increased, yet their pre-HT functional status improved, and 5 year post-HT survival remained unchanged and favorable. In era 2, at the time of HT, patients with HCM were more frequently than their NICM and ICM counterparts in the ICU and supported with inotropes. In the same era, 1 and 5 year survival were more favorable in HCM compared to ICM and comparable to NICM.

Heart Transplantation after Univentricular Palliation: Improved Outcomes and Increased Complexity

Heart transplantation (HT) in patients with failing univentricular circulation is often challenging. This is compounded by the ever-increasing number of patients with prior Norwood-type reconstruction of the aorta, large aortic root, and often dense adhesions from multiple prior operations. We aimed to elucidate differences in outcomes of HT in patients with prior univentricular palliations, with and without prior Norwood-type aortic arch reconstruction (ArchRec). All patients who underwent HT for failed univentricular palliation during the 1990-2022 period were included in the study. Of 45 patients, 18 had undergone ArchRec. Hospital mortality improved in the recent era (17.4% before 2006 vs 0% after 2006; p=0.11), despite a higher proportion of patients with ArchRec (17.4% before 2006 vs 60.8% after 2006, p=0.002). Patients with ArchRec had a higher number of prior cardiac surgeries (4.1±1.5 vs 3.2±1.3, p=0.04), longer cardiopulmonary bypass time (320±23 vs 242±21 min, p=0.02), more concomitant arch reconstruction (33.3% vs 0%, p=0.02), greater need for post-HT extracorporeal membrane oxygenation (33.3% vs 3.7%; p=0.01) and longer hospital stay (37.1±30.5 days vs 23.6±11.8 days, p=0.04). Freedom from death or retransplantation for all patients was 91%, 73%, 67%, and 53% at 1, 5, 10, and 15-years, respectively. Prior ArchRec, Fontan procedure, and earlier eras were not risk factors for death. The outcomes of HT after univentricular palliation have improved in recent times and low operative mortality can be achieved. Despite increased complexity, good similar outcomes can be achieved in patients with and without prior arch reconstruction regardless of the palliation stage.

Comparative Analysis of Clinical Outcomes for COVID-19 and Influenza among Cardiac Transplant Recipients in the United States.

COVID-19 infections can lead to worse outcomes in an immunocompromised population with multiple comorbidities, e.g., heart transplant patients. We used the National Inpatient Sample database to compare heart transplant outcomes in patients with COVID-19 vs. influenza. A total of 2460 patients were included in this study: heart transplant with COVID-19 (n = 1155, 47.0%) and heart transplant with influenza (n = 1305, 53.0%) with the primary outcome of in-hospital mortality. In-hospital mortality (n = 120) was significantly higher for heart transplant patients infected with COVID-19 compared to those infected with influenza (9.5% vs. 0.8%, adjusted OR: 51.6 [95% CI 4.3-615.9], p = 0.002) along with significantly higher rates of mechanical ventilation, acute heart failure, ventricular arrhythmias, and higher mean total hospitalization cost compared to the influenza group. More studies are needed on the role of vaccination and treatment to improve outcomes in this vulnerable population.

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

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.

(879) Heart Transplant Outcomes in Patients ≥65 Years Old with Previous Non-Transplant Cardiac Surgery

(879) Heart Transplant Outcomes in Patients ≥65 Years Old with Previous Non-Transplant Cardiac Surgery

(3) Heart Transplantation Outcomes in Patients from Socioeconomically Distressed Communities

(3) Heart Transplantation Outcomes in Patients from Socioeconomically Distressed Communities

Heart Transplant Outcomes in Patients with Urgent Listing Priority in Canada

<h3>Purpose</h3> Patients waiting for heart transplant (HT) urgently in Canada are listed status 4, defined as mechanically ventilated on inotropes, dependent on temporary mechanical circulatory support (T-MCS), or with durable left ventricular assist device (LVAD) complications. Our objectives were to describe wait time and survival to HT for status 4 patients and describe their post-HT outcomes. <h3>Methods</h3> We conducted a retrospective review of consecutive adults (≥ 18 y) listed for HT using the Canadian Blood Services database and evaluated post-HT outcomes in patients transplanted status 4 at 5 centers between 2013-2019. We evaluated the incidence of HT and death/delisting using competing risk analyses. Post-HT survival was assessed using Kaplan-Meier survival estimates and compared using the logrank test. <h3>Results</h3> Of 204 listed status 4, 81% survived to HT. Time to HT for status 4 patients was 24 (IQR 8-101) days and significantly shorter compared to all listing groups except 3.5 (Fig). Adjusting for age, sex, blood group, height and weight, patients listed status 4 were more likely to survive to HT (HR 1.37, 95% CI: 1.08-1.74) and equally likely to die or be delisted (HR 1.55, 95% CI: 0.90-2.69), Fig). The urgent indication for 62 patients transplanted status 4 was: T-MCS (48%), LVAD complication (40%), refractory ventricular arrhythmia not on T-MCS (6%), and other (5%). Of 30 patients on T-MCS pre-HT, 17% were supported with IABP, 30% with VA-ECMO, and 53% with CentriMag. 30-day and 1-year survival were 95% for the overall cohort. Over 2.9 (IQR 1.6-4.7) years of follow up, cumulative post-HT survival was comparable between patients transplanted from VA-ECMO vs. other status 4 indications, and patients transplanted from any T-MCS vs. no T-MCS (p=0.13, p=0.69 respectively). <h3>Conclusion</h3> Patients listed urgent priority status 4 have acceptable wait times to HT and are not more likely to die waiting compared to other listing groups. Patients transplanted status 4, including those bridged with T-MCS, achieve good short-term post-HT survival.

Heart Transplantation Outcomes in Patients with Marfan Syndrome: UNOS Registry Analysis

Marfan syndrome (MS) is an autosomal dominant connective tissue disorder that causes a defect in the gene fibrillin-1. MS patients develop advanced cardiomyopathies, in which previous studies have demonstrated the presence of a discrete cardiomyopathy associated with MS. Given the vascular complications associated with MS and unclear impact immunosuppression may have on systemic vascular disease, little evidence guides suitability of patients with MS for heart transplant. We sought to investigate long-term heart transplant outcomes of patients with MS listed in the UNOS registry. The UNOS database was queried for all cardiac transplants in the registry from 1987 to 2019 to compare characteristics and outcomes of patients with MS and all other heart transplant patients. Hazard ratios (HR) were calculated using multivariate Cox proportional hazard regression analysis. Survival curves were generated with Kaplan Meier method. Between 1987 and 2019, 22 patients with MS were listed for a heart transplant with a mean age of 35.0 ± 16.3 years. Most patients were male (73%) and Caucasian (73%). Patients with MS were more likely to have prior cardiac surgery (non-transplant) compared to all other heart transplant patients (54.5% vs. 18.3%, p < 0.001). They were as likely to be on life support, including IABP and VAD, but more likely to be on ventilator support (p=0.029). Mean waitlist time were similar, 94.0 days (MS patients) vs 83.0 days (all other patients, p=0.54). There was no significant difference in ischemic time. Transplant survival outcomes were similar at 150 months post-HT (Figure, p=0.69). Survival of Marfan patients was comparable to non-Marfan patients despite increased surgical complexity and greater association with prior cardiac surgery. While further study is warranted, heart transplant is a suitable treatment option in patients with Marfan syndrome and advanced heart failure.

Heart Transplant Outcomes in Patients with Alcoholic Cardiomyopathy

We sought to better characterize differences in transplant outcomes between patients with alcoholic cardiomyopathy and those with other forms of cardiomyopathy in a national cohort. 63,142 OHT recipients were identified from UNOS (1987-2019) of which 224 had alcoholic cardiomyopathy as indication for HT. Multivariate Cox proportional hazard regression analysis was adjusted for age, sex, DM2, ethnicity, ischemic time, dialysis, life support, waitlist time and HLA mismatch. Kaplan-Meier survival curves were generated comparing survival outcomes in patients with alcoholic cardiomyopathy vs. patients with non-alcoholic cardiomyopathy post-OHT, including ischemic, restrictive, dilated, hypertrophic and other. The alcoholic cardiomyopathy group had 224 patients and the non-alcoholic cardiomyopathy group had 62,918 patients. Both cohorts were similar in age, diabetes, smoking status, ischemic time, and need for mechanical support prior to HT. The alcoholic cardiomyopathy cohort was more likely to be male (p<0.001), Black or Hispanic (p<0.001), and history of prior cardiac surgery (p<0.001). No difference in waitlist time was observed. The alcoholic cardiomyopathy cohort had a PRA greater than 20% (p=0.004) and was more likely to die of cardiovascular causes (p=0.005). Overall survival (1, 5, 10 years) was alcoholic cardiomyopathy (85, 67, 47%), non-alcoholic cardiomyopathy (87, 73, 54%) (log rank p=0.0105). 12-year survival for alcoholic cardiomyopathy patients was worse than any other type of cardiomyopathy group (Figure). Post-HT Survival was the lowest in the alcoholic cardiomyopathy cohort compared to post-HT outcomes for all other types of cardiomyopathies. Patient with alcoholic cardiomyopathy tended to have greater sensitization and prior cardiac surgery, however further study is warranted to further delineate factors contributing to this impaired survival.

Pediatric waitlist and heart transplant outcomes in patients with syndromic anomalies.

We sought to determine whether the presence of a systemic SA with potential complicating factors affects waitlist and post-HT outcomes in pediatric patients. This is a single-center retrospective review of pediatric patients listed for HT between January 1, 2009, and July 1, 2018. Patients were selected based on the presence of any underlying syndromes, which included chromosomal anomalies, skeletal myopathies, connective tissue disorders, mitochondrial disease,and other systemic disorders. Waitlist and post-HT outcomes were compared to those without SA. A total of 243 patients were listed for HT, of which 21 (9%) patients had associated SA. Of those, 16 (76%) survived to transplant, 3 (14%) died while on the waitlist, 1 (5%) improved and was removed from the waitlist, and 1 (5%) patient is currently listed. Waitlist survival was not different between those with/without an associated syndrome (P=1.0). Among those who survived to HT, there was no difference in listing days (70 vs 90, P=.8), survival to hospital discharge [14 (93%) vs 150 (95%), P=.6], post-HT intubation days (2 vs 2days, P=.6), or post-HT hospital length of stay (18 vs 18days, P=.8). Overall survival during the study period post-HT was not different between groups (P=.8). A SA was present in 9% of pediatric patients wait-listed for HT, but was not associated with an increased waitlist mortality or post-HT hospital morbidity or long-term survival. For several anomalies, HT is safe and feasible.

Heart transplantation outcomes in patients with continuous-flow left ventricular assist devices

Introduction Durable continuous-flow left ventricular assist devices (CF-LVAD) are used increasingly as both destination and bridge to heat transplant (HTx), in end stage heart failure. Data on long-term survival post-HTx in patients supported with CF-LVAD compared to those undergoing de novo heart transplantation are inconsistent. Some studies show no difference and others indicate increased long-term mortality in patients on mechanical circulatory support (MCS) pre-transplant.1,2,3 Methods We retrospectively reviewed all 153 patients who had OHT in the last 5 years in a tertiary cardiac hospital. Patients were divided into two groups (1) those without mechanical circulatory support pre-transplant (n = 90), (2) and those who were bridged with implantable long-term CF-LVAD (n = 34), all other patients were excluded. Pre-transplant and peri-operative factors, as well as early and late outcomes were then compared between groups. Results Baseline pre-transplant factors were the same between groups, though patients bridged with MCS were more likely to have had a previous stroke (8.9% vs 29.4%, p = 0.008). The time spent on cardiopulmonary bypass was longer (168 vs 202 minutes, p = 0.004) in MCS group. Intraoperative haemoglobin was significantly lower in the MCS group (85g/l vs 79g/l, p = 0.01), and intraoperative lactate was significantly higher (7.9 vs 10.6, p = 0.002). The initial post-operative LVEF was lower (p = 0.004), and there was a trend towards developing severe PGD (18.9 % vs 32.3%, p = 0.054) in the MCS group. Early outcomes were similar with an equal need for renal replacement therapy (p = 0.19) and similar length of stay in ITU (p = 0.17). Despite similar 30-day mortality (p = 0.213), 60-day (p = 0.058) and 1-year mortality (Non-MCS 11.1% versus MCS 32.4%, p = 0.008)(Log-rank (Mantel-Cox) p = 0.11) were significantly higher in the MCS group. Kaplan Mayer curves show significant difference in estimated survival between the groups (Fig 1). Discussion Our results in agreement with present literature show comparable 30-d mortality in both subpopulations, however, indicate increased risk of death in 1-year follow-up.

Heart transplant outcomes in patients with Chagas cardiomyopathy in the United States.

Chagas cardiomyopathy (CC) is one of the chronic manifestations of Trypanosoma cruzi (T.cruzi) infection and is among the leading reasons for heart transplantation (HT) in Latin America. Chagas disease is also present in areas with large Hispanic communities in the United States. Our objective is to evaluate the outcomes of cardiac allograft recipients with the diagnosis of CC in the United States. We identified 25 adult patients with CC and 15930 with idiopathic dilated cardiomyopathy (IDCMP) who underwent HT between 1987 and 2015. CC patients were mostly Hispanics, had lower mean pulmonary artery pressure (23 vs 29mmHg, P=.035) and lower BMI (24 vs 26, P=.007). Patients with CC were more likely to be supported with a total artificial heart (TAH) as bridge to transplant (P=.009). There were no statistical differences for overall mortality and graft survival between CC and IDCMP cardiac allograft recipients. Induction therapy and mycophenolate mofetil (MMF) use were associated with higher rate of infection in Chagas patients. Heart transplantation recipients with CC diagnosis appear to have similar outcomes to IDCMP patients. Induction therapy and MMF use may be associated with higher risk of infection in CC patients who underwent transplantation.

Heart Transplant Outcomes in Patients Listed for Kidney Transplant

Heart Transplant Outcomes in Patients Listed for Kidney Transplant

(944) - Contemporary Analysis of Heart Transplantation Outcomes in Patients with Neuromuscular Cardiomyopathies

(944) - Contemporary Analysis of Heart Transplantation Outcomes in Patients with Neuromuscular Cardiomyopathies

Heart transplant outcomes in patients with left ventricular non-compaction cardiomyopathy

Left ventricular non-compaction cardiomyopathy (LVNCC) is a rare disease that starts in utero and may progress to heart failure (HF), sometimes requiring orthotopic heart transplantation (OHT). There are limited data addressing characteristics of LVNCC patients that require OHT and their outcomes. We therefore sought to investigate the characteristics and outcomes of LVNCC patients treated with OHT. We queried the United Network for Organ Sharing (UNOS) database for all patients listed for OHT with LVNCC as the primary heart failure etiology between 2000 and 2013. We examined their characteristics at listing and outcomes after OHT and compared the findings with those of patients with idiopathic cardiomyopathy (IDCMP). We identified 113 patients (43 adults and 70 pediatrics) with LVNCC of 45,298 patients (0.25% overall, 0.11% of adults and 1.0% of pediatrics) listed for OHT in this time period. Most were male children with mean age at listing of 16.9 years. Compared with the overall IDCMP cohort, patients with LVNCC were younger, had higher use of inotropes and extracorporeal membrane oxygenation (ECMO), and were more often listed as UNOS Status 1A with shorter waiting time. However, when adjusted for age, gender and ethnicity, these differences disappeared. During transplant listing, 8 (7.9%) died, 5 (5.0%) improved and avoided transplant, 3 (3.0%) became too sick for transplant and 78 (77.2%) underwent OHT. There was a non-significant trend toward longer cardiac allograft survival in patients with LVNCC (10.6 vs. 9.4 years; log-rank test, p = 0.068). Patients with LVNCC had similar outcomes to other IDCMP patients, except for more post-transplant infections (50.0% vs. 21.6%, p < 0.05). LVNCC patients undergoing heart transplantation are mostly pediatric and predominantly bridged to transplant with inotropes or ECMO. Despite having more post-transplant infections, their survival is similar to that of other IDCMP patients.

Heart transplantation outcomes in patients with continuous-flow left ventricular assist device-related complications

Device-related complications (DRC) can develop in patients supported with continuous-flow left ventricular assist devices (CF-LVADs). We studied the heart transplant (HTx) outcomes of United Network of Organ Sharing (UNOS) Status 1A patients supported with CF-LVADs with (+) or without (-) DRCs. UNOS data (2006 to 2012) for patients listed under Status 1A with CF-LVADs at the time of HTx were analyzed. Outcomes were compared between the DRC+ and DRC- groups. The DRC+ group was further analyzed under 5 UNOS categories: B1 to B5. Of the 6,799 patients who received HTx under 1A listing, 2,113 (31%) were supported with CF-LVADs. From 2006 to 2012, patients supported with CF-LVADs under the 1A listing increased from 11.4% to 41.5% (p = 0.0001). The DRC+ group (45%) compared with the DRC- group (55%) had longer waiting times (330 ± 323 days vs 168 ± 298 days), more patients with blood group O (57% vs 40%), and a higher body mass index (29 ± 5.5 kg/m(2) vs 27 ± 5 kg/m(2)). Most of the DRCs were in the B2 category (54%). Post-HTx survival for the DRC+ group was significantly reduced compared with the DRC- group at 1 year (85.6% vs 89.9%, p = 0.01) and at 3 years (78% vs 82.7%, p = 0.01), primarily due to B2 category. An increasing number of patients receiving HTx under 1A listing are supported with CF-LVADs. DRCs are steadily increasing, with most of them from the B2 category. Post-HTx survival in DRC+ group is inferior, primarily for the B2 category. The benefits of CF-LVADs for patients awaiting HTx need to be weighed against the development of DRCs with subsequently inferior post-HTx survival.

(255) - Heart Transplantation Outcomes in Patients with Continuous Flow Left Ventricular Assist Device Related Complications

(255) - Heart Transplantation Outcomes in Patients with Continuous Flow Left Ventricular Assist Device Related Complications

(472) - Comparison of Heart Transplant Outcomes in Patients Who Received an Axial Versus Centrifugal Flow LVAD as Bridge to Transplant

PurposeContinuous flow left ventricular assist devices (LVAD) are frequently used as a bridge to transplant (BTT) in patients with stage D heart failure. There is conflicting data regarding post transplant survival in patients bridged to transplant with a LVAD compared to those who proceed directly to transplant. We assessed post transplant outcomes at our institution among patients who received an axial or centrifugal flow LVAD as compared to those who went directly to transplant.MethodsNinety-seven patients underwent orthotopic heart transplant between January 2008 and October 2013. We performed a retrospective analysis of post transplant outcomes in patients with and without an isolated continuous flow LVAD as BTT. Patients with a permanent RVAD, pulsatile LVAD, re-transplant or dual-organ transplants were excluded. Eighty four patients were included in this analysis.ResultsThere was no statistically significant difference in baseline characteristics and post transplant outcomes between the groups.ConclusionThere was no difference in post transplant outcomes in patients bridged to transplant with an LVAD compared to those who went directly to transplant. There appeared to be a trend toward improved survival in the axial flow group and increased incidence of rejection in the centrifugal flow LVAD group. These findings should be further evaluated in future studies. PurposeContinuous flow left ventricular assist devices (LVAD) are frequently used as a bridge to transplant (BTT) in patients with stage D heart failure. There is conflicting data regarding post transplant survival in patients bridged to transplant with a LVAD compared to those who proceed directly to transplant. We assessed post transplant outcomes at our institution among patients who received an axial or centrifugal flow LVAD as compared to those who went directly to transplant. Continuous flow left ventricular assist devices (LVAD) are frequently used as a bridge to transplant (BTT) in patients with stage D heart failure. There is conflicting data regarding post transplant survival in patients bridged to transplant with a LVAD compared to those who proceed directly to transplant. We assessed post transplant outcomes at our institution among patients who received an axial or centrifugal flow LVAD as compared to those who went directly to transplant. MethodsNinety-seven patients underwent orthotopic heart transplant between January 2008 and October 2013. We performed a retrospective analysis of post transplant outcomes in patients with and without an isolated continuous flow LVAD as BTT. Patients with a permanent RVAD, pulsatile LVAD, re-transplant or dual-organ transplants were excluded. Eighty four patients were included in this analysis. Ninety-seven patients underwent orthotopic heart transplant between January 2008 and October 2013. We performed a retrospective analysis of post transplant outcomes in patients with and without an isolated continuous flow LVAD as BTT. Patients with a permanent RVAD, pulsatile LVAD, re-transplant or dual-organ transplants were excluded. Eighty four patients were included in this analysis. ResultsThere was no statistically significant difference in baseline characteristics and post transplant outcomes between the groups. There was no statistically significant difference in baseline characteristics and post transplant outcomes between the groups. ConclusionThere was no difference in post transplant outcomes in patients bridged to transplant with an LVAD compared to those who went directly to transplant. There appeared to be a trend toward improved survival in the axial flow group and increased incidence of rejection in the centrifugal flow LVAD group. These findings should be further evaluated in future studies. There was no difference in post transplant outcomes in patients bridged to transplant with an LVAD compared to those who went directly to transplant. There appeared to be a trend toward improved survival in the axial flow group and increased incidence of rejection in the centrifugal flow LVAD group. These findings should be further evaluated in future studies.