Dataset Information

Renal Outcomes in Patients Bridged to Heart Transplant With a Left Ventricular Assist Device.

ABSTRACT:

Background

Patients with end-stage heart failure are increasingly being bridged to heart transplant (BTT) with mechanical circulatory support; however the association between a left ventricular assist device (LVAD) BTT strategy and posttransplant renal outcomes is unclear. The aim of this study was to analyze the association of LVAD BTT with the development of posttransplant renal failure using a large national registry.

Methods

We queried the 2009 to 2018 United Network for Organ Sharing registry for all adults undergoing first-time heart or heart-kidney transplantation and stratified patients by use of pretransplant durable LVAD. The primary outcome of interest was posttransplant renal failure, which was evaluated with multivariable logistic regression.

Results

Of 18,307 patients meeting inclusion criteria, 7887 were (43%) and 10,420 were not (57%) BTT with an LVAD. BTT patients had slightly better baseline renal function (estimated glomerular filtration rate, 68.7 vs 65.8 mL/min, P < .001) and were less likely to receive a heart-kidney transplant (2.7% vs 4.8%, P < .001). On multivariable logistic regression, LVAD BTT strategy was not independently associated with posttransplant renal failure (odds ratio, 1.13; 95% confidence interval, 0.86-1.49). Similarly LVAD BTT among patients with preoperative renal dysfunction was not associated with posttransplant renal failure (adjusted odds ratio, 1.40; 95% confidence interval, 0.91-2.18).

Conclusions

BTT with an LVAD does not appear to be associated with worse renal outcomes regardless of baseline renal function. Furthermore, an LVAD BTT strategy in patients with chronic kidney disease may enable clinicians to identify candidates suitable for isolated heart transplantation without increasing their risk for posttransplant renal failure.

SUBMITTER: Jawitz OK

PROVIDER: S-EPMC7332375 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Preformed anti-human leukocyte antigen antibodies have been associated with prolonged wait times and increased mortality in orthotopic heart transplantation. We used United Network for Organ Sharing data to examine panel reactive antibody titers in patients bridged to transplant with left ventricular assist devices.This was a retrospective review of the United Network for Organ Sharing dataset for all patients bridged to orthotopic heart transplantation with a HeartMate II or HeartMate XVE (Thoratec Corp, Pleasanton, Calif) from January 2004 to December 2009. Patients were primarily stratified by device type and secondarily grouped for comparisons by high (>25%) versus low (0%) panel reactive antibody activity (class I and II). Outcomes included survival (30-day and 1-year), treated rejection in the year after orthotopic heart transplantation, and primary graft dysfunction. Cox proportional hazards regression examined 30-day and 1-year survival.A total of 871 patients (56.1%) received the HeartMate II device, and 673 patients (43.9%) received the HeartMate XVE device. Patients with high panel reactive antibody had longer duration on the wait list (205 days [interquartile range, 81-344] vs 124 days [interquartile range, 51-270], P = .01). High panel reactive antibody class II was more common in patients with the HeartMate XVE device (51/547 [9.3%] vs 42/777 [5.4%], P < .001). When the entire cohort was examined together, there was no 30-day or 1-year survival difference based on panel reactive antibody activity. Device type did not affect post-orthotopic heart transplantation survival, and panel reactive antibody activity was not associated with worse mortality in Cox regression. Although panel reactive antibody activity did not affect rejection in the year after orthotopic heart transplantation for either device type, high panel reactive antibody class II was associated with higher rates of primary graft dysfunction for both devices (P < .05).This is the largest modern study to examine the impact of detailed panel reactive antibody information in patients bridged to transplant. High panel reactive antibody levels do not affect drug-treated rejection episodes in the first year post-orthotopic heart transplantation; however, there is an associated higher rate of primary graft dysfunction, regardless of device type. Highly sensitized patients bridged to transplant experience excellent survival outcomes after orthotopic heart transplantation.