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Pre-operative Pulmonary Hypertension for Left Ventricular Assist Device Patients Does Not Adversely Impact Long Term Outcomes following Heart Transplantation: Review of the United Network for Organ Sharing Database
Ann C Gaffey, Jennifer J Chung, Carol W Chen, Mallory L Irons, Michael A Acker, Pavan Atluri
Hospital of the University of Pennsylvania, Philadelphia, PA

OBJECTIVES: Severe pre-transplant pulmonary hypertension (PH) has been associated with adverse short-term clinical outcomes after heart transplantation. Improvement in PH through the use of a left ventricular assist device (LVAD) has enabled a subset of patients to be eligible for heart transplantation. Skepticism remains, however, in the long-term post-transplant survival in patients with continued elevations in PH post-LVAD implant. We investigated the association of pre-transplant PH in BTT patients with post-transplant outcomes in the United Network for Organ Sharing dataset (UNOS).
METHODS: We retrospectively analyzed UNOS adult heart transplant data from June 2004 to December 2013. Pre-transplant pulmonary vascular resistance (PVR) was noted in 48,993 patients (53%). Presence or absence of mechanical support was noted in 3,951 patients (4.3%) The recipients were divided into three cohorts based on PH category: no PH BTT (0-1 Wood units, n= 281), moderate PH BTT (1-3 Wood units, n=1,454), and severe PH BTT (3+ Wood units, n=592). Analysis of morbidity and mortality was conducted.
RESULTS: No differences existed with regard to recipient age (p=0.07), gender (p=0.85), or presence of diabetes (p=0.47), cerebral vascular disease (p=0.60), kidney (p=0.53) or liver dysfunction (p=0.79), and waitlist time (p= 0.42). Donors did not differ in age (p=0.13), gender (p=0.10), left ventricular ejection fraction (p=0.26) or allograft ischemic time (p=0.24). Post-operatively, the incidence of re-operation (p=0.67), stroke (p= 0.48), dialysis (p=0.67), infection (p=0.37), and heart block (p=0.77) were similar amongst the three cohorts. The rate of rejection was low and statistically similar in all three cohorts (4.5%, 2.3%, vs. 3.7%, p=0.33). There was no difference in length of hospital stay (p=0.56). One year (91.6%, 90.0%, vs 87.0%), three year (83.7%,82.5%, vs 81.0%) and 5 year (76.3%, 73.5%, vs. 71.5%) survival were similar in all cohorts, using Kaplan-Meier Survival Analysis (log rank p=0.4310).
CONCLUSIONS: For patients bridged to transplantation with an LVAD, the presence of pre-transplant PH does not appear to affect recipient outcomes following heart transplantation, in this study population. Reconsideration of the role of pulmonary hypertension in post-transplant outcomes may be warranted.


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