Bridge to Transplant with Durable Left Ventricular Assist Device is Associated with Primary Graft Dysfunction Following Heart Transplantation: A Report from the International Consortium on Primary Graft Dysfunction.

The International Consortium on Primary Graft Dysfunction is a multicenter, prospective observational study that has collected data on over 2700 HT recipients to identify clinical risk factors for PGD in the contemporary era. The objective of this study was to determine whether BTT with LVAD is associated with PGD and, if so, to identify the high-risk features of BTT recipients. We collected data from 10 participating sites in Europe, the United States (US), and Canada including donor and recipient demographics, pre- and post-HT hemodynamics, and type and duration of BTT durable LVAD support prior to HT. The primary outcome was ISHLT defined severe PGD. Rates of PGD were compared between BTT and medically managed recipients. Univariate and multivariate logistic regression was performed to identify clinical characteristics associated with an increased risk of PGD in the BTT population. Data from 2763 HT recipients from the consortium were included, 837 recipients were BTT. ISHLT severe PGD was seen in 215 (7.8%). The incidence of PGD was significantly higher in BTT recipients as compared with those who were medically managed (13.6% v. 6.3%, p<0.001). Using data only from BTT recipients, univariate logistic regression identified recipient age, geographic location of transplant, dialysis prior to HT, dilated cardiomyopathy, and CVP/PCWP ratio as significant risk factors for severe PGD. Results of the multivariable model are shown in the Table, where recipient age, location of HT, and CVP/PCWP remained significant. BTT with durable LVAD is associated with an increased risk of severe PGD in the contemporary era. High-risk features for PGD in BTT recipients include pre-transplant renal failure, RV dysfunction as quantified by CVP/PCWP ratio, HT within the United States, and non-ischemic dilated cardiomyopathy. [ABSTRACT FROM AUTHOR]