Primary Graft Dysfunction in Patients Supported With Durable Left Ventricular Assist Devices Before Heart Transplantation.

BACKGROUND Previous single-center studies identified an association between pretransplant durable left ventricular assist device (LVAD) support and severe primary graft dysfunction (PGD) following heart transplantation (HT). OBJECTIVES The current study leverages data from the International Consortium on PGD data to identify trends, quantify outcomes, and identify clinical risk factors of high-risk LVAD-supported patients. METHODS Clinical data and outcomes of interest, including severe PGD, were compared between patients with and without LVAD support at the time of HT. Among LVAD-supported patients, univariate and multivariable logistic regression analysis was performed on a priori defined variables to determine their association with severe PGD. RESULTS The final analysis included 4,125 transplant recipients from 14 HT centers, receiving donor hearts by the donation after brain death strategy, with 1,091 (26%) patients supported by LVADs before HT. A total of 365 patients (8.6%) developed severe PGD: 7.4% of those patients without LVAD support and 12.7% of those with LVAD support (P < 0.001). Mortality at 1 year was significantly lower among patients with severe PGD who were bridged to transplantation with a durable LVAD: 28.8% (95% CI: 22.0%-37.1%) vs 40.7% (95% CI: 34.6%-47.7%); log-rank P = 0.025). Risk factors for severe PGD among LVAD-supported patients included pre-HT creatinine, ratio of central venous pressure to pulmonary capillary wedge pressure (CVP/PCWP ratio), and overall donor ischemic time. CONCLUSIONS HT recipients supported by durable LVADs before HT are at increased risk of PGD, but they experience less mortality associated with this post-transplant complication. Surrogates of venous congestion, including pre-HT creatinine and CVP/PCWP ratio, identify high-risk LVAD-supported patients.