National outcomes of bridge to multiorgan cardiac transplantation using mechanical circulatory support

Cumulative incidence curves (upper panel) that depict an increased incidence of death in patients who received extracorporeal membrane oxygenation (ECMO) while waitlisted for multiorgan transplantation. Curves were produced using Fine–Gray competing risk regression with transplantation as a competing risk. Patients were censored at the time of waitlist removal. Differences in incidence of death between mechanical circulatory support (MCS) types were assessed using the Gray test. The lower panel depicts adjusted survival curves on the basis of a Cox proportional hazards analysis that shows that there was no survival difference between patients bridged to multiorgan transplant with each MCS type and no MCS. This study suggests that ECMO is associated with increased waitlist mortality and the use of MCS bridging should not preclude patients from receiving multiorgan transplants because survival after transplantation does not appear to be compromised by its use. IABP, Intra-aortic balloon pump; TAH, total artificial heart; VAD, ventricular assist device.