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Transplant Outcomes in Destination Therapy Left Ventricular Assist Device Patients

Miller, Robert J. H.*; Moayedi, Yasbanoo*; Sharma, Abhinav*; Haddad, Francois*; Hiesinger, William; Banerjee, Dipanjan*

doi: 10.1097/MAT.0000000000001016
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Left ventricular assist devices (LVAD) can be implanted as either a bridge to transplantation (BTT) or destination therapy (DT). This definition is fluid, as some DT patients undergo transplantation. This study compared posttransplant outcomes between BTT and DT LVAD patients. We performed a retrospective analysis of LVAD patients who underwent cardiac transplantation from 2010 to 2016. Outcomes including mortality, rejection, infection, and overall readmission were assessed with univariable Cox analyses. This cohort included 92 LVAD patients underwent transplantation: 57 BTT, mean age 52 years, and 79% male. The DT group had a longer LVAD support time (median support 406 versus 161 days, p < 0.001) with no significant difference in 1-year survival (BTT 86% and DT 92%, p = 0.52) or survival time (HR 0.89, 95% confidence interval [CI] 0.33–2.41, p = 0.82). Rates of nonfatal adverse events were also similar between BTT and DT patients. In our cohort, DT patients had similar long-term survival and rates of adverse events as compared with BTT, despite a longer time to transplant. This study suggests that transplant outcomes are acceptable for patients initially labeled DT and that a longer duration of LVAD support may not adversely affect posttransplant outcomes.

From the *Section of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, and Department of Medicine, Stanford University, California

Department of Cardiovascular Surgery, division of Cardiac Transplant, and Mechanical Circulatory Support, Stanford University, California.

Submitted for consideration January 2019; accepted for publication in revised form April 2019.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Dr. Dipanjan Banerjee, MD, MSc, 300 Pasteur Drive, Room a260, Stanford, CA 94305. Email: dipanjan@stanford.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs