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Multicenter Study
. 2016 Jan;35(1):34-39.
doi: 10.1016/j.healun.2015.07.007. Epub 2015 Jul 29.

Predictors of 30-day post-transplant mortality in patients bridged to transplantation with continuous-flow left ventricular assist devices--An analysis of the International Society for Heart and Lung Transplantation Transplant Registry

Aaron H Healy  1 , Josef Stehlik  2 , Leah B Edwards  3 , Stephen H McKellar  1 , Stavros G Drakos  2 , Craig H Selzman  4
Affiliations
Multicenter Study

Predictors of 30-day post-transplant mortality in patients bridged to transplantation with continuous-flow left ventricular assist devices--An analysis of the International Society for Heart and Lung Transplantation Transplant Registry

Aaron H Healy et al. J Heart Lung Transplant. 2016 Jan.

Abstract

Background: Continuous-flow (CF) left ventricular assist devices (LVADs) are standard of care for bridging patients to cardiac transplantation. However, existing data about preoperative factors influencing early post-transplant survival in these patients are limited. We sought to determine risk factors for mortality using a large international database.

Methods: All patients in the International Society for Heart and Lung Transplantation Transplant Registry who were bridged to transplantation with CF LVADs between June 2008 and June 2012 were included. Risk factors for mortality within 30 days of transplant were identified. Statistical analysis included multivariable analysis and Kaplan-Meier survival analysis.

Results: During the study period, 2,152 patients with CF LVADs underwent heart transplantation. Post-transplant survival was 95.5% at 30 days. Risk factors for mortality during this window included ventilator support at transplant (hazard ratio [HR] = 5.00, 95% confidence interval [CI] = 1.51-16.58), female recipient/male donor (compared with all other combinations, HR = 3.29, 95% CI = 1.90-5.72), history of hemodialysis (HR = 2.51, 95% CI = 1.14-5.51), and history of coronary bypass grafting (HR = 1.89, 95% CI = 1.19-3.00). Increasing recipient age (p = 0.002), body mass index (p = 0.002), creatinine (p = 0.004), and total bilirubin (p < 0.001) also were associated with an increase in mortality.

Conclusions: In patients supported with CF LVADs, risk factors for early mortality can be identified before transplant, including ventilator support, female recipient/male donor, increasing recipient age, and body mass index. Despite the inherent complexities of a reoperative surgery, patients bridged to transplant with CF LVADs have excellent peri-operative survival.

Keywords: bridge to transplant; continuous flow; outcomes; transplantation; ventricular assist device.

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Conflict of interest statement

Conflict of Interest Statement:

Healy – a 2013 ISHLT Transplant Registry Early Career Award funded this project

Stehlik – none

Edwards – none

McKellar – none

Drakos - none

Selzman - none

Figures

Figure 1
Figure 1
Thirty-Day Post-Transplant Survival in Patients Bridged to Transplantation with a Continuous Flow Left Ventricular Assist Device.
Figure 2
Figure 2
Categorical Risk Factors for Death within 30 Days Among Patients Bridged to Transplantation with a Continuous Flow Left Ventricular Assist Device. Results of a multivariable logistic regression analysis. CABG, Coronary Artery Bypass Grafting; CI, Confidence Interval; Haz, Hazard; LCL, Lower Confidence Limit; TX, Transplant; UCL, Upper Confidence Limit
Figure 3
Figure 3
Continuous, Recipient-Related Risk Factors Independently Associated with Mortality within 30 Days of Transplant Among Patients Bridged to Transplantation with a Continuous Flow Left Ventricular Assist Device Showing the Impact of: (A) Recipient Age; (B) Recipient BMI; (C) Recipient Creatinine (D) Recipient Total Bilirubin; (E) Recipient PA Diastolic Pressure; and (F) Recipient PCW Pressure BMI, Body Mass Index; PA, Pulmonary Artery; PCW, Pulmonary Capillary Wedge
Figure 4
Figure 4
Risk of Donor Age for Mortality within 30 Days of Transplant Among Patients Bridged to Transplantation with a Continuous Flow Left Ventricular Assist Device
See this image and copyright information in PMC

References

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