Marginal Donor Use in Patients Undergoing Heart Transplantation With Left Ventricular Assist Device Explantation.
BACKGROUND
The use of continuous flow (CF) left ventricular assist devices (LVAD) as a bridge to orthotopic heart transplantation (OHT) has increased. This study examined survival outcomes after CF-LVAD explantation and OHT using marginal donors.


METHODS
Adults undergoing OHT with or without LVAD explant using marginal donors between 2007 and 2014 were identified in the Scientific Registry for Transplant Recipients database. A previously validated donor risk score was used to define marginal donors. Patients were stratified into four groups based on utilization of a marginal donor with or without LVAD explantation at OHT. Graft survival was analyzed at 1 and 5 years.


RESULTS
Overall, 7,798 patients with OHT were analyzed. Whereas 1,862 patients (24%) underwent direct OHT utilizing marginal donors, only 626 patients (30% [group A]) underwent OHT with LVAD explant (HeartMate II [Thoratec, Pleasanton, CA], n =581, 93%; HVAD [HeartWare, Framingham, MA], n = 45, 7%) and 1,236 (70%) underwent direct OHT (group B). Standard donors were utilized for 2,334 patients with CF-LVAD explant (group C), and 3,602 patients underwent direct OHT (group D). Utilization of marginal donors in patients undergoing LVAD explantation was associated with decreased posttransplant graft survival (p < 0.001). After adjusting for recipient age, sex, listing status at OHT, body mass index, creatinine, and duration of LVAD support, Cox regression analysis found that patients bridged with LVADs, recipients receiving transplants from marginal donors, recipients with highest age and body mass index, and highest creatinine were at increased risk of graft failure (all p < 0.01).


CONCLUSIONS
Utilization of marginal donors in patients undergoing CF-LVAD explantation and OHT is associated with reduced early and late graft survival. These findings support cautionary use of marginal donors in patients bridged with CF-LVAD.
Division of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Marat
M
Fudim
Department of Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Mary E
ME
Davis
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
Cathy
C
Jenkins
Division of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Christopher L
CL
Brown
Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Mark A
MA
Wigger
Division of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota.
John M
JM
Stulak
Department of Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: simon.maltais@vanderbilt.edu.
Simon
S
Maltais
Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Nicholas
N
Haglund
D000328:Adult; D000367:Age Factors; D000368:Aged; D020878:Device Removal; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult