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462
Impact of Pre-transplant LVAD Therapy on Survival and Infectious Complications in Heart Transplant Recipients

Session: Poster Abstract Session: Transplant Infectious Diseases
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Heart failure has become a major epidemic affecting more than 23 million people worldwide. Approximately 550,000 new cases of heart failure are diagnosed annually in the United States. Orthotropic heart transplantation provides the greatest survival benefit for advanced heart failure. However, the demand for donor hearts far exceeds organ supply. Therefore, implantable left ventricular assist devices (LVADs) are increasingly being used as a bridge to transplantation and often as destination myocardial surrogate therapy.

Objective:To analyze the rate of infectious complications and overall survival in heart transplant recipients with and without prior LVAD therapy. 

Methods: We retrospectively reviewed medical records of all heart transplant recipients from January 2007 to June 2013 at 3 Mayo Clinic sites (Rochester, Arizona and Florida). Patients were excluded if: 1) their LVAD was not a Heartmate II device, 2) they had more than one device prior to transplant, 3) if they had a total artificial heart or RVAD implanted, and 4) if the patient died less than 6 months after transplant.Data including patient demographics, comorbid conditions, details of heart transplantation, infectious complications and survival was compared between patients who received LVAD therapy prior to transplant to those who did not.

Results: Overall, 296 patients were eligible for the study. Of these, 65 (22%) patients had received LVAD therapy prior to heart transplant. Majority of the patients were males (70%) and Caucasian (79%). The two groups were similar in terms of demographics and co-morbid conditions. The presence of pre-transplant LVAD did not have any significant effect on time to first infection after transplant (Hazard Ratio: 1.066, 95% CI [0.664 to 1.714], p=0.79). The rate of post-transplant infections was 1.35 for those who received an LVAD and 1.31 for those who did not, p=0.91. Similarly, no difference was seen between the two groups in terms of patient`s survival (HR of 0.484, 95% CI [0.112 to 2.081], p=0.33)  

Conclusion: The presence of an LVAD prior to heart transplant does not increase rate of infection post-heart transplant and does not adversely affect survival in these patients.

Sana Arif, MBBS1, Randall Walker, MD2, Mark P. Wilhelm, MD2, Michael Keating, MD3, Lisa Brumble, MD4, Holenarasipur Vikram, MD5, Shimon Kusne, MD6, John Stulak7, Richard Daly7, Matthew a. Hathcock, MS8, Daniel Yip9, Juhsien JC Nienaber, MD10 and Muhammad R. Sohail, MD11, (1)Infectious Diseases, Mayo Clinic, Rochester, MN, (2)Mayo Clinic, Rochester, MN, (3)Infectious Diseases, Mayo Clinic Rochester, Rochester, MN, (4)Infectious Diseases, Mayo Clinic Florida, Jacksonville, FL, (5)Mayo Clinic Arizona, Phoenix, AZ, (6)Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ, (7)Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, (8)Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, (9)Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL, (10)Infectious Disease, Mayo Clinic, Rochester, OH, (11)200 First Street SW, Mayo School of Graduate Medical Education, Rochester, MN

Disclosures:

S. Arif, None

R. Walker, None

M. P. Wilhelm, None

M. Keating, None

L. Brumble, None

H. Vikram, None

S. Kusne, None

J. Stulak, None

R. Daly, None

M. A. Hathcock, None

D. Yip, None

J. J. Nienaber, None

M. R. Sohail, None

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