Effect of left ventricular assist device infection on post-transplant outcomes

In this study, we sought to confirm which types of device-related infections impact bridge-to-transplant rates. We also aimed to determine the effect of device-related infections on post-transplant survival and post-transplant infection.

We retrospectively reviewed paper and electronic medical records for 149 patients undergoing left ventricular assist device (LVAD) implantation as a bridge to transplantation at the Columbia Presbyterian Medical Center between 2000 and 2006. The primary outcome measures were survival to transplantation, post-transplant infection and post-transplant survival.

Patients with sepsis were less likely to be successfully bridged to cardiac transplantation (7 of 22 vs 103 of 127, 31.8% vs 81.1%, p = 0.01). However, if transplanted, their survival rates at 1 year were not decreased (6 of 7 vs 85 of 103, 85.7% vs 82.5%, p = 1.00). No other pre-transplant device-related infection affected post-transplant survival at 1 year (22 of 27 vs 69 of 83, 81.5% vs 83.1%, p = 1.00). Pre-transplant drive-line infections predicted post-transplant infection in former drive-line or pocket sites (11 of 16 vs 14 of 94, 68.8% vs 14.9%, p = 0.01) and increased overall post-transplant hospital length of stay (16 vs 19 days, p = 0.04). They did not, however, affect post-transplant survival at 1 year (22 of 25 vs 69 of 85, 88% vs 81.2%, p = 0.56).

Although survival to transplantation was diminished in LVAD patients with sepsis, if successfully transplanted, post-transplant survival was unaffected. Patients with local device infections and signs of early sepsis may warrant evaluation for urgent transplantation. A pre-transplant drive-line infection was associated with post-transplant infection in either the former pocket or drive-line site, and increased overall length of stay, but it did not decrease post-transplant survival.