title: Ventricular assist devices and increased blood product utilization for cardiac transplantation.
abstract: OBJECTIVE
  The purpose of this study was to examine whether blood product utilization, one-year cell-mediated rejection rates, and mid-term survival significantly differ for ventricular assist device (VAD patients compared to non-VAD (NVAD) patients following cardiac transplantation.
  
  
  METHODS
  From July 2004 to August 2011, 79 patients underwent cardiac transplantation at a single institution. Following exclusion of patients bridged to transplantation with VADs other than the HeartMate II® LVAD (n = 10), patients were stratified by VAD presence at transplantation: VAD patients (n = 35, age: 54.0 [48.0-59.0] years) vs. NVAD patients (n = 34, age: 52.5 [42.8-59.3] years). The primary outcomes of interest were blood product transfusion requirements, one-year cell-mediated rejection rates, and mid-term survival post-transplantation.
  
  
  RESULTS
  Preoperative patient characteristics were similar for VAD and NVAD patients. NVAD patients presented with higher median preoperative creatinine levels compared to VAD patients (1.3 [1.1-1.6] vs. 1.1 [0.9-1.4], p = 0.004). VAD patients accrued higher intraoperative transfusion of all blood products (all p ≤ 0.001) compared to NVAD patients. The incidence of clinically significant cell-mediated rejection within the first posttransplant year was higher in VAD compared to NVAD patients (66.7% vs. 33.3%, p = 0.02). During a median follow-up period of 3.2 (2.0, 6.3) years, VAD patients demonstrated an increased postoperative mortality that did not reach statistical significance (20.0% vs. 8.8%, p = 0.20).
  
  
  CONCLUSIONS
  During the initial era as a bridge to transplantation, the HeartMate II® LVAD significantly increased blood product utilization and one-year cell-mediated rejection rates for cardiac transplantation. Further study is warranted to optimize anticoagulation strategies and to define causal relationships between these factors for the current era of cardiac transplantation.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Stone
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.forename: Ehsan
authors.initials: E
authors.lastname: Benrashid
authors.forename: David C
authors.initials: DC
authors.lastname: Scalzo
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
authors.forename: James D
authors.initials: JD
authors.lastname: Bergin
authors.forename: Randal S
authors.initials: RS
authors.lastname: Blank
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
mesh_terms: D000328:Adult; D001688:Biological Products / Q000627:therapeutic use*; D001802:Blood Substitutes / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001688:Biological Products; D001802:Blood Substitutes