Pulmonary Hypertension Results in Worse Post-Transplant Survival in Left Ventricular Assist Device Patients

This study examines the effects of pulmonary hypertension (PH) on post-transplant survival in patients with and without a continuous flow left ventricular assist device (CFVAD). The United Network of Organ Sharing database was retrospectively queried from January 2005 to June 2015 to identify adult patients undergoing heart transplant. This population was divided into patients with and without a CFVAD. The population was analyzed to define PH (mean pulmonary artery pressure ≥ 25 mmHg) both at listing and at time of transplant. Four groups were defined: patients who never had PH, always had PH, PH resolved, and developed PH between listing and transplant. Kaplan-Meier analysis was used to compare survival. A total of 15914 patients underwent heart transplant of which 4662 (29%) were implanted with a CFVAD. Of the total population, 10872 (68%) had PH at time of listing and 9661 (61%) had PH at time of transplant. Characteristics are shown in Table 1. Survival was significantly worse for patients with a CFVAD who had PH at time of transplant (p=0.010). Sub-analysis revealed worse survival for CFVAD patients with unresolved PH (p=0.022). Kaplan-Meier showed worse survival for patients with a CFVAD who developed PH by the time of transplant but improved survival for patients with resolved PH while on CFVAD therapy (Figure 1, p=0.052). PH at time of transplant results in worse survival for patients with a CFVAD. Furthermore, the development of PH while on CFVAD therapy negatively impacts post-transplant survival. Additional analysis to determine patients likely to improve PH on CFVAD therapy is needed.