Effects of Systemic and Device-Related Complications in Patients Bridged to Transplantation With Left Ventricular Assist Devices

Cecillia Lui, Alejandro Suarez-Pierre, Xun Zhou, Todd C. Crawford, Charles Fraser, Katherine Giuliano, Steven Hsu, Robert S. Higgins, Kenton J. Zehr, Glenn J. Whitman, Chun W. Choi, Ahmet Kilic

Research output: Contribution to journalArticle

Abstract

Background: The use of left ventricular assist devices (LVADs) as a bridge to heart transplantation has increased rapidly over the last 2 decades. We aim to explore the effect of pretransplant systemic and device-related complications on posttransplant survival for patients bridged with LVADs. Materials and methods: The United Network of Organ Sharing (Organ Procurement and Transplantation Network) database was queried for all adult heart transplant recipients (aged ≥ 18 y) transplanted from April 1, 2015, to June 31, 2018. Device-related complications included thrombosis, device infection, device malfunction, life-threatening arrhythmia, and other device complications. Systemic complications included a new dialysis need or ventilator dependence between the time of listing and transplantation, transfusion, or systemic infection requiring treatment with intravenous antibiotics within 2 wk of transplantation. Results: A total of 2131 patients were identified as requiring LVAD support before transplantation. LVAD patients had high rates of preoperative systemic complications (53%) and high rates of device-related complications (42.7% experienced at least one device-related complication). Kaplan–Meier analysis revealed a significantly decreased 1-y survival for LVAD patients bridged to transplantation who experienced a pretransplant systemic complication (P = 0.041). Interestingly, preoperative device-related complications had no effect on 1-y posttransplantation survival (P = 0.93). Multivariate Cox modeling revealed that systemic complications were associated with a significantly increased risk of posttransplant mortality for LVAD patients (hazard ratio 1.45; P = 0.033). Conclusions: Recipients who suffered a systemic complication while awaiting heart transplantation experienced higher short-term mortality rates. Device-related complications do not appear to impact posttransplantation outcomes.

Original languageEnglish (US)
Pages (from-to)207-212
Number of pages6
JournalJournal of Surgical Research
Volume246
DOIs
StatePublished - Feb 1 2020

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Heart-Assist Devices
Transplantation
Equipment and Supplies
Heart Transplantation
Survival
Tissue and Organ Procurement
Mortality
Organ Transplantation
Mechanical Ventilators
Infection
Cardiac Arrhythmias
Dialysis
Thrombosis
Databases
Anti-Bacterial Agents

Keywords

  • Device-related complications
  • Heart transplantation
  • Left ventricular assist device
  • Systemic complications

ASJC Scopus subject areas

  • Surgery

Cite this

Effects of Systemic and Device-Related Complications in Patients Bridged to Transplantation With Left Ventricular Assist Devices. / Lui, Cecillia; Suarez-Pierre, Alejandro; Zhou, Xun; Crawford, Todd C.; Fraser, Charles; Giuliano, Katherine; Hsu, Steven; Higgins, Robert S.; Zehr, Kenton J.; Whitman, Glenn J.; Choi, Chun W.; Kilic, Ahmet.

In: Journal of Surgical Research, Vol. 246, 01.02.2020, p. 207-212.

Research output: Contribution to journalArticle

Lui, C, Suarez-Pierre, A, Zhou, X, Crawford, TC, Fraser, C, Giuliano, K, Hsu, S, Higgins, RS, Zehr, KJ, Whitman, GJ, Choi, CW & Kilic, A 2020, 'Effects of Systemic and Device-Related Complications in Patients Bridged to Transplantation With Left Ventricular Assist Devices', Journal of Surgical Research, vol. 246, pp. 207-212. https://doi.org/10.1016/j.jss.2019.08.016
Lui, Cecillia ; Suarez-Pierre, Alejandro ; Zhou, Xun ; Crawford, Todd C. ; Fraser, Charles ; Giuliano, Katherine ; Hsu, Steven ; Higgins, Robert S. ; Zehr, Kenton J. ; Whitman, Glenn J. ; Choi, Chun W. ; Kilic, Ahmet. / Effects of Systemic and Device-Related Complications in Patients Bridged to Transplantation With Left Ventricular Assist Devices. In: Journal of Surgical Research. 2020 ; Vol. 246. pp. 207-212.
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abstract = "Background: The use of left ventricular assist devices (LVADs) as a bridge to heart transplantation has increased rapidly over the last 2 decades. We aim to explore the effect of pretransplant systemic and device-related complications on posttransplant survival for patients bridged with LVADs. Materials and methods: The United Network of Organ Sharing (Organ Procurement and Transplantation Network) database was queried for all adult heart transplant recipients (aged ≥ 18 y) transplanted from April 1, 2015, to June 31, 2018. Device-related complications included thrombosis, device infection, device malfunction, life-threatening arrhythmia, and other device complications. Systemic complications included a new dialysis need or ventilator dependence between the time of listing and transplantation, transfusion, or systemic infection requiring treatment with intravenous antibiotics within 2 wk of transplantation. Results: A total of 2131 patients were identified as requiring LVAD support before transplantation. LVAD patients had high rates of preoperative systemic complications (53{\%}) and high rates of device-related complications (42.7{\%} experienced at least one device-related complication). Kaplan–Meier analysis revealed a significantly decreased 1-y survival for LVAD patients bridged to transplantation who experienced a pretransplant systemic complication (P = 0.041). Interestingly, preoperative device-related complications had no effect on 1-y posttransplantation survival (P = 0.93). Multivariate Cox modeling revealed that systemic complications were associated with a significantly increased risk of posttransplant mortality for LVAD patients (hazard ratio 1.45; P = 0.033). Conclusions: Recipients who suffered a systemic complication while awaiting heart transplantation experienced higher short-term mortality rates. Device-related complications do not appear to impact posttransplantation outcomes.",
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T1 - Effects of Systemic and Device-Related Complications in Patients Bridged to Transplantation With Left Ventricular Assist Devices

AU - Lui, Cecillia

AU - Suarez-Pierre, Alejandro

AU - Zhou, Xun

AU - Crawford, Todd C.

AU - Fraser, Charles

AU - Giuliano, Katherine

AU - Hsu, Steven

AU - Higgins, Robert S.

AU - Zehr, Kenton J.

AU - Whitman, Glenn J.

AU - Choi, Chun W.

AU - Kilic, Ahmet

PY - 2020/2/1

Y1 - 2020/2/1

N2 - Background: The use of left ventricular assist devices (LVADs) as a bridge to heart transplantation has increased rapidly over the last 2 decades. We aim to explore the effect of pretransplant systemic and device-related complications on posttransplant survival for patients bridged with LVADs. Materials and methods: The United Network of Organ Sharing (Organ Procurement and Transplantation Network) database was queried for all adult heart transplant recipients (aged ≥ 18 y) transplanted from April 1, 2015, to June 31, 2018. Device-related complications included thrombosis, device infection, device malfunction, life-threatening arrhythmia, and other device complications. Systemic complications included a new dialysis need or ventilator dependence between the time of listing and transplantation, transfusion, or systemic infection requiring treatment with intravenous antibiotics within 2 wk of transplantation. Results: A total of 2131 patients were identified as requiring LVAD support before transplantation. LVAD patients had high rates of preoperative systemic complications (53%) and high rates of device-related complications (42.7% experienced at least one device-related complication). Kaplan–Meier analysis revealed a significantly decreased 1-y survival for LVAD patients bridged to transplantation who experienced a pretransplant systemic complication (P = 0.041). Interestingly, preoperative device-related complications had no effect on 1-y posttransplantation survival (P = 0.93). Multivariate Cox modeling revealed that systemic complications were associated with a significantly increased risk of posttransplant mortality for LVAD patients (hazard ratio 1.45; P = 0.033). Conclusions: Recipients who suffered a systemic complication while awaiting heart transplantation experienced higher short-term mortality rates. Device-related complications do not appear to impact posttransplantation outcomes.

AB - Background: The use of left ventricular assist devices (LVADs) as a bridge to heart transplantation has increased rapidly over the last 2 decades. We aim to explore the effect of pretransplant systemic and device-related complications on posttransplant survival for patients bridged with LVADs. Materials and methods: The United Network of Organ Sharing (Organ Procurement and Transplantation Network) database was queried for all adult heart transplant recipients (aged ≥ 18 y) transplanted from April 1, 2015, to June 31, 2018. Device-related complications included thrombosis, device infection, device malfunction, life-threatening arrhythmia, and other device complications. Systemic complications included a new dialysis need or ventilator dependence between the time of listing and transplantation, transfusion, or systemic infection requiring treatment with intravenous antibiotics within 2 wk of transplantation. Results: A total of 2131 patients were identified as requiring LVAD support before transplantation. LVAD patients had high rates of preoperative systemic complications (53%) and high rates of device-related complications (42.7% experienced at least one device-related complication). Kaplan–Meier analysis revealed a significantly decreased 1-y survival for LVAD patients bridged to transplantation who experienced a pretransplant systemic complication (P = 0.041). Interestingly, preoperative device-related complications had no effect on 1-y posttransplantation survival (P = 0.93). Multivariate Cox modeling revealed that systemic complications were associated with a significantly increased risk of posttransplant mortality for LVAD patients (hazard ratio 1.45; P = 0.033). Conclusions: Recipients who suffered a systemic complication while awaiting heart transplantation experienced higher short-term mortality rates. Device-related complications do not appear to impact posttransplantation outcomes.

KW - Device-related complications

KW - Heart transplantation

KW - Left ventricular assist device

KW - Systemic complications

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