Impella 5.5 versus intra-aortic balloon pump for bridging dual organ heart-kidney transplants: Analysis of the UNOS...

There has been an exponential increase in the utilization of temporary mechanical support devices for bridging Status 2 heart transplant candidates. The aim of our study is to determine outcomes in dual organ heart/kidney recipients for patients bridged with an Impella 5.5 versus IABP.

We evaluated the UNOS database and analyzed Status 2 patients who underwent dual organ heart/kidney transplantation after being bridged with an Impella 5.5 or IABP from October 2019 (time of Impella 5.5 FDA approval) until March 2024.

A total of 457 patients who underwent Heart/Kidney transplant (HKT) were identified, of which 73% (334/457) were bridged with an IABP and 27% (123/457) with an Impella 5.5. Within the IABP cohort, 37% (122/334) were on dialysis pre-transplant compared to 43% (53/123) in the Impella group (p = 0.409). Patients in the Impella group had worse functional status, liver function, and filling pressures. There was no difference in the need for dialysis post-transplant (32% vs 29%, p = 0.613). Survival at 30, 180, and 360 days and the rates of primary graft dysfunction, acute, and chronic rejection were similar between the two groups.

Both IABP and Impella appear to be safe for bridging dual organ heart and kidney transplant candidates, with comparable post-transplant heart and kidney graft function, complications, and survival up to 2 years. Patients receiving Impella 5.5 appear to be sicker and as a result, this percutaneous temporary mechanical circulatory support device may confer some advantages, especially for patients with dual organ failure who undergo transplantation.