title: Heart transplantation outcomes in patients with continuous-flow left ventricular assist device-related complications.
abstract: BACKGROUND
  Device-related complications (DRC) can develop in patients supported with continuous-flow left ventricular assist devices (CF-LVADs). We studied the heart transplant (HTx) outcomes of United Network of Organ Sharing (UNOS) Status 1A patients supported with CF-LVADs with (+) or without (-) DRCs.
  
  
  METHODS
  UNOS data (2006 to 2012) for patients listed under Status 1A with CF-LVADs at the time of HTx were analyzed. Outcomes were compared between the DRC+ and DRC- groups. The DRC+ group was further analyzed under 5 UNOS categories: B1 to B5.
  
  
  RESULTS
  Of the 6,799 patients who received HTx under 1A listing, 2,113 (31%) were supported with CF-LVADs. From 2006 to 2012, patients supported with CF-LVADs under the 1A listing increased from 11.4% to 41.5% (p = 0.0001). The DRC+ group (45%) compared with the DRC- group (55%) had longer waiting times (330 ± 323 days vs 168 ± 298 days), more patients with blood group O (57% vs 40%), and a higher body mass index (29 ± 5.5 kg/m(2) vs 27 ± 5 kg/m(2)). Most of the DRCs were in the B2 category (54%). Post-HTx survival for the DRC+ group was significantly reduced compared with the DRC- group at 1 year (85.6% vs 89.9%, p = 0.01) and at 3 years (78% vs 82.7%, p = 0.01), primarily due to B2 category.
  
  
  CONCLUSIONS
  An increasing number of patients receiving HTx under 1A listing are supported with CF-LVADs. DRCs are steadily increasing, with most of them from the B2 category. Post-HTx survival in DRC+ group is inferior, primarily for the B2 category. The benefits of CF-LVADs for patients awaiting HTx need to be weighed against the development of DRCs with subsequently inferior post-HTx survival.
authors.affiliation: Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia. Electronic address: mquader@mcvh-vcu.edu.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Quader
authors.affiliation: Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Luke G
authors.initials: LG
authors.lastname: Wolfe
authors.affiliation: Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Vigneshwar
authors.initials: V
authors.lastname: Kasirajan
mesh_terms: D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014768:Virginia / Q000453:epidemiology; D014850:Waiting Lists / Q000401:mortality*
keywords: United Network of Organ Sharing; continuous-flow; device-related complications; heart transplantation; left ventricular assist device