Complications of left ventricular assist devices causing high urgency status on waiting list: impact on outcome after heart transplantation

Abstract

Aims Heart transplantation (HTx) represents optimal care for advanced heart failure. Left ventricular assist devices (LVADs) are often needed as a bridge-to-transplant (BTT) therapy to support patients during the wait for a donor organ. Prolonged support increases the risk for LVAD complications that may affect the outcome after HTx. Methods and results A total of 342 patients undergoing HTx after LVAD as BTT in a 10-year period in two German high-volume HTx centres were retrospectively analysed. While 73 patients were transplanted without LVAD complications and with regular waiting list status (T, n = 73), the remaining 269 patients were transplanted with high urgency status (HU) and further divided with regard to the observed leading LVAD complications (infection: HU1, n = 91; thrombosis: HU2,

Impact of Cardiopulmonary Resuscitation of Donors on Days Alive and Out of Hospital after Orthotopic Heart Transplantation

“…The number of patients waiting for heart transplantation (HTX) is constantly increasing due to factors such as demographic shift and improved medical treatment [1][2][3][4][5][6][7][8]. The 2 of 9 number of available donor hearts, however, does not match the high demand for these organs.…”

Impact of pretransplant left ventricular assist device support duration on outcome after heart transplantation

“…Regardless the fact that we do not observe any impact of the duration of LVAD support on outcome after HTx, we do observe a negative impact of LVAD therapy itself on outcome after HTx. This finding is still divergent with registry data that could not report any impact of LVAD therapy on post-transplant outcome at all [ 5 , 8 , 10 ].…”

“…In contrast to that, the observed kind of device-related complications differed between the 4 groups. However, in a previous published two-centre study, we were able to show that the different device-related complications such as right heart failure, infections, stroke or thrombosis do not impact the outcome after HTx [ 10 ].…”

“…While the occurrence of device-related complications did not seem to be associated with decreased postoperative survival after HTx, the impact of support duration remains another potential significant factor [ 7 , 9 , 10 ]. During LVAD therapy, patients often experience humoral sensitization leading to an increased risk of circulating human leukocyte antigen- and cytotoxic panel-reactive antibodies that may later trigger antibody-mediated rejection and carries the risk of development of cardiac allograft vasculopathy [ 6 , 11–14 ].…”

Unraveling the Causes of Primary Graft Dysfunction

“…4 With the continual donor shortage, transplantation increasingly is an option reserved for the most critically ill patients or ones who have been on MCS devices for a protracted period of time. 6 Therefore, the recipients are physiologically distinct from those who previously were transplanted as outpatients, on oral medical therapy for heart failure. We are also pushed to make compromises on donor factors such as age as we try to get patients a transplant before they are too ill to survive the surgery.…”