Regev, O

Abstract Background Renal dysfunction is a major determinant of outcomes after heart transplantation (HT). While baseline renal impairment and post-HT dialysis are known predictors of mortality, the prognostic impact of sustained pre-HT renal decline in patients bridged with durable left ventricular assist devices (LVADs) remains unclear. Methods We conducted a retrospective, multicenter cohort study using the United Network for Organ Sharing (UNOS) registry to identify adult patients who underwent HT following durable LVAD support between 2009 and 2024. Sustained renal decline was defined as a ≥40% reduction in estimated glomerular filtration rate (eGFR) from listing to HT. Multivariable logistic regression identified predictors of renal decline and post-HT dialysis,while Cox proportional hazards models assessed the impact on post-HT mortality. Results Among 10,454 eligible patients, 624 (6.0%) experienced sustained renal decline during LVAD bridging. Compared with patients without renal decline, affected patients had longer waitlist durations (median 297 vs. 197 days; p<0.001), lower eGFR at HT (42.0 vs. 70.6 mL/min/1.73 m²; p<0.001), and higher rates of post-HT dialysis (23.7% vs. 12.8%; p<0.001). Independent predictors of sustained renal decline included longer waitlist time, perioperative blood transfusions, while the use of HeartMate 3 LVAD was protective. Sustained renal decline was independently associated with increased risk of post-HT dialysis (adjusted odds ratio [aOR] 2.64) and all-cause mortality (adjusted hazard ratio [aHR] 1.16),with post-HT dialysis strongly predicting mortality (aHR 3.48). Conclusions Sustained renal deterioration while awaiting HT is a significant predictor of post-HT dialysis and mortality in LVAD-bridged patients. Incorporating renal trajectory into risk stratification may enhance candidate selection and promote perioperative renal protection strategies.

Abstract Background In light of the updated lowered threshold for diagnosing pulmonary hypertension (PH), the reversibility of precapillary PH with left ventricular assist device (LVAD) and the associated post heart transplantation (HT) outcomes remain unclear. Purpose and methods Using data from the United Network for Organ Sharing database, we aimed to investigate predictors of persistent precapillary PH in HT recipients bridged with LVAD, and examine the interrelated post-HT survival, using the updated pulmonary vascular resistance (PVR) cutoff of >2 WU for precapillary PH. Results Among 2169 HT recipients bridged with LVAD, 1299 had PVR>2 at baseline; 551 (42.4%) of whom normalized their PVR≤2 and 748 (57.6%) remained with elevated PVR>2 after LVAD implantation. Female sex (adjusted odds ratio [aOR] 2.22, 95% confidence interval [CI]:1.61-3.07, p<0.001) and inotropes-treatment at-listing (aOR 1.31, 95% CI: 1.03-1.66, p=0.028) were associated with persistently elevated PVR post LVAD. Conversely, longer duration of LVAD support (aOR 0.74, 95% CI: 0.65-.84, p<0.001) and use of HeartMate 2 (aOR 0.74, CI: 0.59-0. 93, p=0.011) were protective against persistently elevated PVR post-LVAD. Persistently elevated PVR >2 post-LVAD was associated with increased risk of death compared to those who normalized their PVR (adjusted hazard ratio [aHR] 1.26, 95% CI: 1.01-1.57, p=0.037). However, normalized PVR post-LVAD group had comparable survival to those with PVR≤2 at baseline (aHR 0.76, 95% CI: 0.57-1.02, p=0.07). Conclusions Many HT recipients bridged with LVAD remain with PVR>2 post-LVAD implantation, which is associated with increased risk of death post-HT compared to patients with normalized PVR post-LVAD.