A preliminary analysis of the use of long-term ventricular assist devices on outcomes for patients on the UK heart transplant list.

9952 

Abstract Submission 

John Louca (1), Marco Öchsner (2), Sai Bhagra (3), Alex Manara (4), Simon Messer (5), Sally Rushton (6), Aravinda Page (7), Nicole Asemota (3), Marius Berman (8), Stephen Large (3)

(1) University of Cambridge, Northwood, United Kingdom, (2) University of Cambridge, Cambridge, NA, (3) Royal Papworth Hospital, Cambridge, NA, (4) Southmead Hospital, Bristol, NA, (5) Golden Jubilee Hospital, Glasgow, NA, (6) NHS Blood & Transplant, Bristol, NA, (7) Royal Papworth Hospital NHS Foundation Trust, Cambridge, NA, (8) Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom

John Louca    -  Contact Me
University of Cambridge

Marco Öchsner    -  Contact Me
University of Cambridge

Sai Bhagra    -  Contact Me
Royal Papworth Hospital

Alex Manara    -  Contact Me
Southmead Hospital

Simon Messer    -  Contact Me
Golden Jubilee Hospital

Sally Rushton    -  Contact Me
NHS Blood & Transplant

Aravinda Page    -  Contact Me
Royal Papworth Hospital NHS Foundation Trust

Nicole Asemota    -  Contact Me
Royal Papworth Hospital

Marius Berman    -  Contact Me
Royal Papworth Hospital NHS Foundation Trust

Stephen Large    -  Contact Me
Royal Papworth Hospital

John Louca    -  Contact Me
University of Cambridge

Objective: It is estimated that one third of patients listed on the heart transplant waiting list in the UK do not receive a transplant. In recent years there has been an increase in the dependence of ventricular assisted devices to optimise patients on the waiting list pre-transplant. However, there has yet to be a single study formally analysing the outcomes of patients listed on the UK heart transplant waiting list.

Methods: A retrospective analysis of the NHS Blood & Transplant database that included all patients aged >15 listed on the heart transplant list between 1st January 2008 – 31st December 2022.

Results: In this time period only 65% of patients listed for heart transplantation in the UK go one to receive a heart. In patients who did not receive mechanical circulatory support before transplantation, 76% went onto receive a heart transplant. In patients who received long-term ventricular assist devices (LT-VAD) pre-transplant, significantly fewer received a transplant - only 35%. This group of patients also had significantly higher rates of removal from and death on the list. 28 % of patients with LT-VADs are removed from the list compared to only 14% of patients with no MCS pre-transplant. 22% of patients with LT-VADs die on the list, compared to 7% of patients not requiring MCS.

Secondary to this patients on LT-VADs pre-transplant had significantly worse survival post-transplant compared to those on short-term mechanical circulatory support (p=0.05) and not requiring mechanical circulatory support (p<0.005). Moreover, these patients had a higher dependence on mechanical circulatory support post-transplant (26.5% compared to 14.3% in those not requiring MCS post-transplant). Moreover, these differences persisted across different time periods (2008-2015 and 2016-2022).

Conclusions: Patients on LT-MCS are significantly less likely to receive a heart and significantly more likely to have worse outcomes post-transplant in the UK. This may be in part because these patients wait significantly longer before receiving a heart. There is a need to review the practice of VAD implantation in the UK to ensure that this group of patients have their outcomes optimised and understand how to improve outcomes for VAD patients in the UK currently. There is a need for further studies with greater granularity and a need to collect quality of life data for VAD patients in normal clinical practice.

Heart Transplant