Posttransplant Long-Term Outcomes for Patients with Ventricular Assist Devices on the Heart Transplant Waitlist

Whitbread, James J.; Etchill, Eric; Giuliano, Katherine; Suarez‐Pierre, Alejandro; Lawton, Jennifer S.; Hsu, Steven; Sharma, Kavita; Choi, Chun Woo; Higgins, Robert S.D.; Kilic, Ahmet

doi:10.1097/mat.0000000000001611

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…On multivariable analysis, patients with LVADs had a 44% higher mortality risk within the first 3 months post-transplant (p = 0.03) [19]. And the trend was persistent through the next 9 months as patients with LVADs had statistically borderline 21% increased risk of death within the first year post-transplant conditional on 3 months of post-transplant survival (p = 0.06) [19].…”

Section: Discussionmentioning

confidence: 99%

“…Survival rate of unsupported patients was as high as 87.2% (83.6-90.2) [18]. A large analysis by Whitbread JJ et al including 20,113 transplant recipients with 45% supported with LVAD showed that among those who died after transplantation, patients with LVADs on average died sooner (1.8 years) than patients without LVADs (3.0 years; p < 0.01) [19]. On multivariable analysis, patients with LVADs had a 44% higher mortality risk within the first 3 months post-transplant (p = 0.03) [19].…”

Section: Discussionmentioning

confidence: 99%

“…A large analysis by Whitbread JJ et al including 20,113 transplant recipients with 45% supported with LVAD showed that among those who died after transplantation, patients with LVADs on average died sooner (1.8 years) than patients without LVADs (3.0 years; p < 0.01) [19]. On multivariable analysis, patients with LVADs had a 44% higher mortality risk within the first 3 months post-transplant (p = 0.03) [19]. And the trend was persistent through the next 9 months as patients with LVADs had statistically borderline 21% increased risk of death within the first year post-transplant conditional on 3 months of post-transplant survival (p = 0.06) [19].…”

Section: Discussionmentioning

confidence: 99%

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Advanced Respiratory Failure Requiring Tracheostomy—A Marker of Unfavourable Prognosis after Heart Transplantation

Załęska-Kocięcka,

Morosin,

Dutton

et al. 2024

Diagnostics

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Advanced respiratory failure with tracheostomy requirement is common in heart recipients. The aim of the study is to assess the tracheostomy rate after orthotopic heart transplantation and identify the subgroups of patients with the highest need for tracheostomy and these groups’ association with mortality at a single centre through a retrospective analysis of 140 consecutive patients transplanted between December 2012 and July 2018. As many as 28.6% heart recipients suffered from advanced respiratory failure with a need for tracheostomy that was performed after a median time of 11.5 days post-transplant. Tracheostomy was associated with a history of stroke (OR 3.4; 95% CI) 1.32–8.86; p = 0.012), previous sternotomy (OR 2.5; 95% CI 1.18–5.32; p = 0.017), longer cardiopulmonary bypass time (OR 1.01; 95% CI 1.00–1.01; p = 0.007) as well as primary graft failure (OR 6.79; 95% CI2.93–15.71; p < 0.001), need of renal replacement therapy (OR 19.2; 95% 2.53–146; p = 0.004) and daily mean SOFA score up to 72 h (OR 1.50; 95% 1.23–1.71; p < 0.01). One-year mortality was significantly higher in patients requiring a tracheostomy vs. those not requiring one during their hospital stay (50% vs. 16%, p < 0.001). The need for tracheostomy in heart transplant recipients was 30% in our study. Advanced respiratory failure was associated with over 3-fold greater 1-year mortality. Thus, tracheostomy placement may be regarded as a marker of unfavourable prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Advanced Respiratory Failure Requiring Tracheostomy—A Marker of Unfavourable Prognosis after Heart Transplantation

Załęska-Kocięcka,

Morosin,

Dutton

et al. 2024

Diagnostics

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“…Further, weight-gain in patients on VAD is not infrequent. Among VAD patients subsequently transplanted, increased BMI was associated with post-transplantation complications[ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

Hatzianastasiou,

Vlachos,

Stravopodis

et al. 2024

World J Transplant

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BACKGROUND Transplant recipients commonly harbor multidrug-resistant organisms (MDROs), as a result of frequent hospital admissions and increased exposure to antimicrobials and invasive procedures. AIM To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition, as well as the impact of MDRO acquisition on intensive care unit (ICU) and hospital length of stay, and on ICU mortality and 1-year mortality post heart transplantation. METHODS This retrospective cohort study analyzed 98 consecutive heart transplant patients over a ten-year period (2013-2022) in a single transplantation center. Data was collected regarding MDROs commonly encountered in critical care. RESULTS Among the 98 transplanted patients (70% male), about a third (32%) acquired or already harbored MDROs upon transplantation (MDRO group), while two thirds did not (MDRO-free group). The prevalent MDROs were Acinetobacter baumannii (14%), Pseudomonas aeruginosa (12%) and Klebsiella pneumoniae (11%). Compared to MDRO-free patients, the MDRO group was characterized by higher body mass index (P = 0.002), higher rates of renal failure (P = 0.017), primary graft dysfunction (10% vs 4.5%, P = 0.001), surgical re-exploration (34% vs 14%, P = 0.017), mechanical circulatory support (47% vs 26% P = 0.037) and renal replacement therapy (28% vs 9%, P = 0.014), as well as longer extracorporeal circulation time (median 210 vs 161 min, P = 0.003). The median length of stay was longer in the MDRO group, namely ICU stay was 16 vs 9 d in the MDRO-free group (P = 0.001), and hospital stay was 38 vs 28, (P = 0.006), while 1-year mortality was higher (28% vs 7.6%, log-rank-χ 2: 7.34). CONCLUSION Following heart transplantation, a predominance of Gram-negative MDROs was noted. MDRO acquisition was associated with higher complication rates, prolonged ICU and total hospital stay, and higher post-transplantation mortality.

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“…A recent multivariable analysis even showed that that prior MCS (LVAD and biventricular VAD) was associated with reduced 1-year mortality and comparable 5-year survival rates (65% vs. 60%, respectively) [ 29 ]. Another study showed that the BTT is associated with a potentially higher risk of post-transplant mortality, especially within 1 year after transplantation [ 30 ]. There are several studies available with different results regarding the postoperative outcomes of BTT patients compared to primary HTx patients [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ].…”

Section: Btt or Primary Htxmentioning

confidence: 99%

LVAD as a Bridge to Transplantation—Current Status and Future Perspectives

Roesel,

Nersesian,

Neuber

et al. 2024

Rev. Cardiovasc. Med.

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Heart failure (HF) is a common disease associated with high morbidity and mortality rates despite advanced pharmacological therapies. Heart transplantation remains the gold standard therapy for end-stage heart failure; however, its application is curtailed by the persistent shortage of donor organs. Over the past two decades, mechanical circulatory support, notably Left Ventricular Assist Devices (LVADs), have been established as an option for patients waiting for a donor organ. This comprehensive review focuses on elucidating the benefits and barriers associated with this application. We provide an overview of landmark clinical trials that have evaluated the use of LVADs as a bridge to transplantation therapy, with a particular focus on post-transplant outcomes. We discuss the benefits of stabilizing patients with these systems, weighing associated complications and limitations. Further technical advancements and research on optimal implantation timing are critical to ultimately improve outcomes and securing quality of life. In a world where the availability of donor organs remains constrained, LVADs are an increasingly important piece of patient care, bridging the critical gap to transplantation in advanced heart failure management.

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Posttransplant Long-Term Outcomes for Patients with Ventricular Assist Devices on the Heart Transplant Waitlist

Cited by 7 publications

References 21 publications

Advanced Respiratory Failure Requiring Tracheostomy—A Marker of Unfavourable Prognosis after Heart Transplantation

Advanced Respiratory Failure Requiring Tracheostomy—A Marker of Unfavourable Prognosis after Heart Transplantation

Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

LVAD as a Bridge to Transplantation—Current Status and Future Perspectives

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