Left ventricular assist device is protective against cardiac transplant delisting for medical unsuitability

Background: Left ventricular assist device (LVAD) related complications have the potential to disqualify patients for heart transplantation. We sought to determine whether LVAD support was associated with increased rates of delisting due to medical unsuitability or clinical deterioration. Methods: The analysis included adult candidates listed for first-time heart transplantation in the UNOS registry in the contemporary, continuous flow (CF)- LVAD era (2010–2016). The exposure variable was LVAD support on the waitlist. The primary outcome was time to delisting due to medical unsuitability or clinical deterioration. As cardiac transplantation and death represent competing risks in this study, a Fine-Gray cox regression analysis was performed. Results: Data on 16,913 patients listed for heart transplant were analyzed. During a median follow up of 150 days, 1206 (7.1%) patients died, 10,083 (60%) were transplanted, and 1224 (7.2%) were delisted due to medical unsuitability or clinical deterioration. Presence of a LVAD at listing was associated with a reduced rate (hazard) of delisting both in the adjusted and unadjusted models (unadjusted HR 0.63, 95% CI 0.55–0.73, adjusted HR 0.78, 95% CI 0.67–0.90). Delayed LVAD while on the list was not associated with reduced rates of delisting (adjusted HR 0.91, 95% CI 0.79–1.1). Conclusions: Continuous flow left ventricular assist device support was protective against delisting in this UNOS analysis. These data would suggest that despite the adverse event rate of mechanical support, improving cardiac output may be important to preserving the overall health of the potential cardiac transplant recipient.