Impact of high urgency listing and VAD implantation on post-heart transplant survival

Objectives: The clinical preoperative status mainly predicts the outcome post-transplant. Recipients with a limited hemodynamic status or with complications on VAD-support might receive the urgency-status from Eurotransplant. We analyze the impact of urgency-listing and VAD-support on the outcome post-transplant.

Methods: 409 heart transplants were performed between 4/1990 and 8/2009. We analyzed four groups: transplant on urgency-list (U-group); on urgency-list and VAD-support (U-VAD-group); on normal waiting-list without VAD-support (N-group) and with VAD-support (N-VAD-group).

Results: Almost one-third of all transplants were performed with urgency-listing and with previous VAD-support (Table). Patients with a VAD were significant younger. The overall waiting-time for cardiac transplant was non-significant different between the groups. However, waiting-time on the urgency-list was significantly longer in VAD supported patients. Mortality post-transplant was the highest in patients with previous VAD-support, despite urgency-listing.

Conclusion: Early outcome post-transplant in urgency patients without VAD support is comparable to the outcome from the elective waiting list. Previous VAD bridging has a negative impact on survival post-transplant in both the elective and the urgency group.

Table Outcome for different transplant groups

Values	N group	N-VAD group	U group	U-VAD group	p value
Total	255 (62.4%)	43 (10.5%)	40 (9.9%)	71 (17.4%)
Age, years	52±14	40±15*	49±18	39±16*	.000 (*vs N and U group)
Gender, male	205 (80.4%)	37 (86%)	27 (68%)	56 (79%)	.187
Overall waiting time, days	222±293	209±167	161±186	278±208	.150
Waiting time (urgency list), days			29±35	49±57	.041
Previous cardiac operation	67 (26.3%)		15 (38%)		.001
30-day mortality	38 (14.9%)	10 (23.3%)	1 (2.5%)	16 (22.5%)	.022