title: Predictors of 30-day post-transplant mortality in patients bridged to transplantation with continuous-flow left ventricular assist devices--An analysis of the International Society for Heart and Lung Transplantation Transplant Registry.
abstract: BACKGROUND
  Continuous-flow (CF) left ventricular assist devices (LVADs) are standard of care for bridging patients to cardiac transplantation. However, existing data about preoperative factors influencing early post-transplant survival in these patients are limited. We sought to determine risk factors for mortality using a large international database.
  
  
  METHODS
  All patients in the International Society for Heart and Lung Transplantation Transplant Registry who were bridged to transplantation with CF LVADs between June 2008 and June 2012 were included. Risk factors for mortality within 30 days of transplant were identified. Statistical analysis included multivariable analysis and Kaplan-Meier survival analysis.
  
  
  RESULTS
  During the study period, 2,152 patients with CF LVADs underwent heart transplantation. Post-transplant survival was 95.5% at 30 days. Risk factors for mortality during this window included ventilator support at transplant (hazard ratio [HR] = 5.00, 95% confidence interval [CI] = 1.51-16.58), female recipient/male donor (compared with all other combinations, HR = 3.29, 95% CI = 1.90-5.72), history of hemodialysis (HR = 2.51, 95% CI = 1.14-5.51), and history of coronary bypass grafting (HR = 1.89, 95% CI = 1.19-3.00). Increasing recipient age (p = 0.002), body mass index (p = 0.002), creatinine (p = 0.004), and total bilirubin (p < 0.001) also were associated with an increase in mortality.
  
  
  CONCLUSIONS
  In patients supported with CF LVADs, risk factors for early mortality can be identified before transplant, including ventilator support, female recipient/male donor, increasing recipient age, and body mass index. Despite the inherent complexities of a reoperative surgery, patients bridged to transplant with CF LVADs have excellent peri-operative survival.
authors: Department of Surgery, University of Utah, Salt Lake City, Utah.
authors: Aaron H
authors: AH
authors: Healy
authors: Department of Medicine, University of Utah, Salt Lake City, Utah.
authors: Josef
authors: J
authors: Stehlik
authors: International Society for Heart and Lung Transplantation, Addison, Texas.
authors: Leah B
authors: LB
authors: Edwards
authors: Department of Surgery, University of Utah, Salt Lake City, Utah.
authors: Stephen H
authors: SH
authors: McKellar
authors: Department of Medicine, University of Utah, Salt Lake City, Utah.
authors: Stavros G
authors: SG
authors: Drakos
authors: Department of Surgery, University of Utah, Salt Lake City, Utah. Electronic address: craig.selzman@hsc.utah.edu.
authors: Craig H
authors: CH
authors: Selzman
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology*; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D016041:Heart-Lung Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012955:Societies, Medical; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: bridge to transplant; continuous flow; outcomes; transplantation; ventricular assist device