Renal Outcomes in Patients Bridged to Heart Transplant With a Left Ventricular Assist Device

BACKGROUND: Patients with end stage heart failure are increasingly being bridged to heart transplant (BTT) with mechanical circulatory support (MCS), however the association between a left ventricular assist device (LVAD) BTT strategy and post-transplant renal outcomes is unclear. The aim of this study was to analyze the association of LVAD BTT with the development of post-transplant renal failure using a large national registry. METHODS: We queried the 2009-2018 United Network for Organ Sharing (UNOS) registry for all adults undergoing first-time heart or heart-kidney transplantation and stratified patients by use of pre-transplant durable LVAD. The primary outcome of interest was post-transplant renal failure, which was evaluated with multivariable logistic regression. RESULTS: 18,307 patients met inclusion criteria including 7,887 (43%) and 10,420 (57%) that were and were not bridged to transplant with an LVAD, respectively. BTT patients had slightly better baseline renal function (eGFR 68.7 vs 65.8 mL/min, p<0.001) and were less likely to receive a heart-kidney transplant (2.7% vs 4.8%, p<0.001). On multivariable logistic regression, LVAD BTT strategy was not independently associated with post-transplant renal failure (OR 1.13, 95% CI 0.86-1.49). Similarly, LVAD BTT among patients with preoperative renal dysfunction was not associated with post-transplant renal failure (AOR 1.40, 95% CI 0.91-2.18). CONCLUSIONS: BTT with an LVAD does not appear to be associated with worse renal outcomes regardless of baseline renal function. Furthermore, an LVAD BTT strategy in patients with chronic kidney disease may enable clinicians to identify candidates suitable for isolated heart transplantation without increasing their risk for post-transplant renal failure