Temporal Trends and Outcomes of Patients on Left Ventricular Assist Devices and Inotropes at the Time Listing for Heart Transplant.

Purpose Evaluate the prevalence, temporal trends and outcomes of patients with left ventricular assist devices and inotropes at the time of listing for heart transplantation. Methods Patients ≥ 18 years old with an LVAD implanted and listed with 1A status were identified in the United Network for Organ Sharing (UNOS) registry between Jan 2010 and Dec 2017, with follow-up through March 2018. Patients were grouped according to the presence or absence of inotropes at the time of listing. The primary outcomes were mortality on the waiting list or transplantation. Since the occurrence of one of the outcomes will prevent the other from manifesting, we accounted for this by use of competing risks regression. Variables that were adjusted for include age, gender, race, BMI, diabetes, prior cardiac surgery, dialysis-dependent, cerebrovascular disease and presence of an implanted defibrillator. Results A total of 2,714 patients were included in the study. The temporal trend of LVAD patients on inotropic therapy at the time of listing and at the time of transplant is shown in figure 1. Patients on inotropes are younger(49.8 (14.0) vs 52.5 (12.4) p<0.001), less likely to be white(56.7% vs 62.2% p=0.01) and have higher wedge pressure (24.1mmHg (8.4)vs 17.7mmHg (9.5) p <0.001) and higher mean pulmonary arterial pressure (33.8mmHg (10.0) vs 27.0mmHg (10.2)p<0.001). Patients on LVAD and inotropes at the time of listing had higher risk of dying in the waiting list sub-hazard ratio (SHR) =1.48 (95% CI=1.14, 1.90), p=0.002 and were less likely to be transplanted SHR= 0.70 (95% CI=0.63, 0.78), p<0.001 after adjusting for described confounders. Conclusion Approximately 1 in 5 patient on LVAD support is on inotropic therapy at the time of listing for heart transplantation. Patients on LVAD and inotropes have worse outcomes in term of survival and chances of being transplanted. The impact of the new allocation system in these patients remains to be seen. [ABSTRACT FROM AUTHOR]