TY - JOUR
T1 - Marginal donor use in patients undergoing heart transplantation with left ventricular assist device explantation
AU - Fudim, Marat
AU - Davis, Mary E.
AU - Jenkins, Cathy
AU - Brown, Christopher L.
AU - Wigger, Mark A.
AU - Stulak, John M.
AU - Maltais, Simon
AU - Haglund, Nicholas
N1 - Funding Information:
Dr Haglund was funded by a Training in Cardiovascular Research Grant (T32HL007411). This work was also funded by a Clinical and Population Research Award from the American Heart Association (14CRP18900004).
Publisher Copyright:
© 2015 The Society of Thoracic Surgeons.
PY - 2015
Y1 - 2015
N2 - 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.
AB - 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.
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U2 - 10.1016/j.athoracsur.2015.05.110
DO - 10.1016/j.athoracsur.2015.05.110
M3 - Article
C2 - 26338051
AN - SCOPUS:84940703628
SN - 0003-4975
VL - 100
SP - 2117
EP - 2126
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -