Bridge with a left ventricular assist device to a simultaneous heart and kidney transplant: Review of the United Network for Organ Sharing database.
BACKGROUND
Left ventricular assist device (LVAD) implantation as a bridge to cardiac transplantation (BTT) is an effective treatment for end-stage heart failure patients. Currently, there is an increasing number of patients with a LVAD who need a heart and kidney transplant (HKT). Little is known of the prognostic outcomes in these patients. This study was undertaken to determine whether an equivalent outcome would be present in HKTs as compared to a non-LVAD primary HKT cohort.


METHODS
We reviewed the United Network for Organ Sharing database from 2004 to 2013. Orthotropic heart transplant recipients (n = 49 799) were subcategorized as dual organ HKT (n = 1 921) and then divided into cohorts of HKT following continuous flow left ventricular assist device placement (CF-VAD-HKT, n = 113) or no LVAD placement (HKT, n = 1 808). Survival after transplantation was analyzed.


RESULTS
For CF-LVAD-HKT and HKT cohorts, preoperative characteristics were similar regarding age (50.8 ± 13.7, 50.1 ± 13.7, p = 0.75) and panel reactive antibody (12.3 ± 18.4 vs 7.1 ± 18.4, p = 0.06). Donors were similar in age, gender, creatinine, and ejection fraction. Post-transplant, there was no difference in complications. Survival for CF-LVAD-HKT and HKT were similar at 1 year (77% vs 82%) and 3 years (75% vs 77%, log rank p = 0.2814).


CONCLUSIONS
For patients with advanced heart failure and persistent renal dysfunction, simultaneous HKT is a safe option. Survival after CF-LVAD-HKT is equivalent to conventional HKT.
Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia.
Ann C
AC
Gaffey
Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia.
Carol W
CW
Chen
Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia.
Jennifer
J
Chung
Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia.
Edward Wilson
EW
Grandin
Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia.
Paige M
PM
Porrett
Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia.
Michael A
MA
Acker
Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia.
Pavan
P
Atluri
D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D019737:Transplants; D016896:Treatment Outcome
dual organ transplants; heart failure; transplant