What If the Destination Is Transplant? Outcomes of Destination Therapy Patients Who Were Transplanted

Area of Science:

• Cardiology
• Transplantation Medicine
• Medical Devices

Background:

• Destination therapy (DT) using ventricular assist devices (VADs) like the HeartWare Ventricular Assist Device (HVAD) is a treatment option for advanced heart failure.
• Heart transplantation (HTx) is the gold standard for eligible patients with end-stage heart failure.
• Characterizing patients who transition from DT to HTx is crucial for understanding treatment pathways and outcomes.

Purpose of the Study:

• To analyze the characteristics of patients who underwent heart transplantation (HTx) after receiving a HeartWare Ventricular Assist Device (HVAD) for destination therapy (DT) in the combined ENDURANCE/ENDURANCE Supplemental Trials (DT/DT2).
• To compare baseline characteristics, adverse events, and reasons for transplant between patients who did and did not receive HTx.
• To compare the time to HTx in DT/DT2 patients with those in the HVAD Bridge-to-Transplant (BTT) trial.

Main Methods:

• A post hoc analysis of data from the DT/DT2 trials involving 604 HVAD patients was conducted.
• Baseline characteristics and adverse events were compared between the HTx cohort (n=80) and the no-HTx cohort.
• Reasons for HTx and time to HTx were examined and compared with contemporaneous HVAD BTT trial patients.

Main Results:

• 13% (80 of 604) of DT/DT2 patients underwent HTx.
• The HTx cohort was younger, had fewer Caucasians, less ischemic cardiomyopathy, and less atrial fibrillation compared to the no-HTx cohort.
• Elective HTx (79%) was often due to behavioral modification and weight loss, while urgent HTx (21%) was primarily due to adverse events. Median time to HTx was longer in DT/DT2 (550 days) than in BTT (285.2 days).

Conclusions:

• Over 10% of patients treated with DT HVAD support in the DT/DT2 trials underwent heart transplantation within three years.
• Patients selected for HTx after DT support were generally younger and had fewer comorbidities.
• Consideration for heart transplantation following DT VAD implant appears feasible for select patients, with elective transplantation often driven by non-medical factors.