Bridge with a left ventricular assist device to a simultaneous heart and kidney transplant: Review of the United Network for Organ Sharing database. Issue 3 (8th February 2017)

• Record Type: Journal Article
• Authors: Gaffey, Ann C.; Chen, Carol W.; Chung, Jennifer; Grandin, Edward Wilson; Porrett, Paige M.; Acker, Michael A.; Atluri, Pavan
• Is Part Of: Journal of cardiac surgery. Volume 32:Issue 3(2017)
• Page Start: 209
• Page End: 214
• Publication Date: 2017-02-08
• Subjects: dual organ transplants -- heart failure -- transplant; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.13105
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: BACKGROUND: Left ventricular assist device (LVAD) implantation as a bridge to cardiac transplantation (BTT) is an effective treatment for end‐stage heart failure patients. Currently, there is an increasing number of patients with a LVAD who need a heart and kidney transplant (HKT). Little is known of the prognostic outcomes in these patients. This study was undertaken to determine whether an equivalent outcome would be present in HKTs as compared to a non‐LVAD primary HKT cohort. METHODS: We reviewed the United Network for Organ Sharing database from 2004 to 2013. Orthotropic heart transplant recipients (n = 49 799) were subcategorized as dual organ HKT (n = 1 921) and then divided into cohorts of HKT following continuous flow left ventricular assist device placement (CF‐VAD‐HKT, n = 113) or no LVAD placement (HKT, n = 1 808). Survival after transplantation was analyzed. RESULTS: For CF‐LVAD‐HKT and HKT cohorts, preoperative characteristics were similar regarding age (50.8 ± 13.7, 50.1 ± 13.7, p = 0.75) and panel reactive antibody (12.3 ± 18.4 vs 7.1 ± 18.4, p = 0.06). Donors were similar in age, gender, creatinine, and ejection fraction. Post‐transplant, there was no difference in complications. Survival for CF‐LVAD‐HKT and HKT were similar at 1 year (77% vs 82%) and 3 years (75% vs 77%, log rank p = 0.2814). CONCLUSIONS: For patients with advanced heart failure and persistent renal dysfunction, simultaneous HKT is a safe option. Survival after CF‐LVAD‐HKT is equivalent to conventional HKT.