Cardiology Fellow Vandalia Health Charleston Area Medical Center Charleston, West Virginia, United States
Disclosure(s):
Mohamed S. Mahmoud, MD: No financial relationships to disclose
Background: Left ventricular assist devices (LVAD) are used as a bridge to heart transplantation (HTx). While LVAD support improves survival to transplant, its association with post-transplant outcomes remains unclear. We compared 30-day and 1-year outcomes after transplantation in patients with and without LVAD support using a multicenter health record network.
Methods: We conducted a retrospective cohort study using the TriNetX Research Network, including adults aged 18–75 years who underwent HTx between January 2016 and December 2025. Patients were stratified by prior LVAD exposure and matched 1:1 using propensity scores incorporating demographics, comorbidities, and peri-transplant medication and hemodynamic support variables, yielding 1,373 patients per group. Outcomes assessed at 30 days and 1 year included right ventricular (RV) failure, all-cause mortality, acute rejection, need for continuous renal replacement therapy (CRRT), repeat transplantation, transplant-related complications, and graft failure. Associations were evaluated using time-to-event analyses and Kaplan–Meier methods.
Outcome: After matching, baseline characteristics were well balanced. At 30 days, LVAD and no-LVAD groups had similar rates of RV failure (6.2% vs 5.0%; HR 1.25, 95% CI 0.91–1.73; p= 0.17), all-cause mortality (1.7% vs 1.9%; HR 0.89, 95% CI 0.51–1.55; p= 0.67), and CRRT (11.7% vs 11.8%; HR 0.99, 95% CI 0.80–1.24; p =0.95). In contrast, LVAD recipients had higher rates of acute rejection (36.9% vs 32.9%; HR 1.16, 95% CI 1.02–1.32; p= 0.02), repeat transplantation (5.8% vs 2.8%; HR 2.07, 95% CI 1.41–3.05; p= 0.003), and transplant-related complications (44.2% vs 40.5%; HR 1.14, 95% CI 1.01–1.28; p= 0.03).
At 1 year, there were again no differences in RV failure (9.2% vs 8.1%; HR 1.14, 95% CI 0.89–1.48; p= 0.41), mortality (6.6% vs 5.8%; HR 1.15, 95% CI 0.85–1.56; p= 0.36), or CRRT (16.2% vs 15.2%; HR 1.07, 95% CI 0.89–1.30; p= 0.86). However, LVAD support remained associated with higher rejection (64.7% vs 61.6%; HR 1.12, 95% CI 1.02–1.23; p= 0.02), repeat transplantation (7.8% vs 4.0%; HR 1.97, 95% CI 1.42–2.73; p= 0.001), and transplant-related complications (74.1% vs 71.7%; HR 1.13, 95% CI 1.03–1.23; p= 0.03). Rates of heart graft failure at 1 year were similar.
Conclusion: In this propensity-matched analysis, pre-transplant LVAD support was not associated with increased mortality, RV failure, or CRRT after HTx. However, LVAD recipients had higher risks of acute rejection, repeat transplantation, and transplant-related complications, highlighting persistent immunologic risk and the need for enhanced peri- and post-transplant management.
