title: Mechanical circulatory support and heart transplantation: donor and recipient factors influencing graft survival.
abstract: BACKGROUND
  Mechanical circulatory support is an accepted strategy to bridge patients to heart transplantation (HTx). Among mechanical circulatory support patients who go on to HTx, factors associated with improved graft survival have not been fully elucidated.
  
  
  METHODS
  Using the Scientific Registry for Transplant Recipients, we identified adults who were treated with a left ventricular assist device (LVAD) or total artificial heart (TAH) before HTx. Kaplan-Meier and multivariate Cox regression models were used to identify patient, donor, and device characteristics associated with graft survival.
  
  
  RESULTS
  Between January 1997 and February 2012, 2,785 adults underwent HTx. Before HTx, 2,674 patients were treated with a LVAD (HeartMate XVE, 724; HeartMate II, 1,882; HeartWare, 68), and 111 were treated with a TAH. Follow-up averaged 25 ± 24 months. Gender mismatch occurred in 23%. Graft survival did not differ between LVAD groups (all p > 0.168), but TAH was associated with reduced graft survival compared with LVADs (p < 0.001). After controlling for device type (LVAD vs TAH), lower recipient pulmonary vascular resistance, shorter ischemic time, younger donor age, donor-to-recipient gender match, and higher donor-to-recipient body mass index ratio were independent predictors of longer graft survival (all p < 0.05).
  
  
  CONCLUSIONS
  TAH was associated with reduced graft survival after transplant, and survival did not differ between the LVAD device groups. Additional variables that were independently associated with graft survival were donor age, recipient peripheral vascular resistance, ischemic time, gender match, and donor-to-recipient body mass index ratio. Recognition of these factors may inform decisions regarding device support and donor suitability.
authors.affiliation: Division of Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: simon.maltais@vanderbilt.edu.
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
authors.affiliation: Division of Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Nikhil P
authors.initials: NP
authors.lastname: Jaik
authors.affiliation: Department of Surgery and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Irene D
authors.initials: ID
authors.lastname: Feurer
authors.affiliation: Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Wigger
authors.affiliation: Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: DiSalvo
authors.affiliation: Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Schlendorf
authors.affiliation: Division of Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Rashid M
authors.initials: RM
authors.lastname: Ahmad
authors.affiliation: Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lenihan
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.affiliation: Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Keebler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D014655:Vascular Resistance; D055815:Young Adult
keywords: 27