Pre-Implant Renal Function and Optimal Outcomes Among Older LVAD Recipients: An STS-INTERMACS Analysis

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

J Heart Lung Transplant

Abstract

Purpose: LVAD recipients are increasingly older and often also have renal dysfunction. For older patients, avoiding adverse events may be as or more important than survival, yet the demographics, comorbidity burden, and impact of renal dysfunction on the risk of sub-optimal outcomes in this population are not well understood. Methods: Using the STS-INTERMACS registry, we analyzed adult patients with INTERMACS profiles 3-7 receiving an isolated first HeartMate 3 LVAD between 6/1/2017 and 6/30/2022. Patients were divided into 3 age groups (<65, 65-70, and >70). To quantify the severities of different adverse events (AEs), we quantified the multivariable-adjusted association between important AEs and 3-year mortality. Regression coefficients were used as the score for each AE, with death assigned a score of 14 (greater than the sum of all individual AE scores, Figure). Patients were classified into outcome score groups at 3 years as follows: 0, alive without AEs; 1-3, alive with low AE burden; 3-<14, alive with high AE burden; 14, dead without AEs; >14, dead with any AEs. Patient characteristics were compared across age and outcome score groups. Results: 4880 patients were included (<65: 3113; 65-70: 767; >70: 1000). Patients <70 were more often white and male, had lower eGFR, and a higher prevalence of frailty compared with patients <65. 3-year survival was 78.3%, 68.6%, and 64.6%, respectively (p<0.001). Patients >70 were less likely to survive with low AE burden compared with patients <65 (62% vs 76%). Survival with low AE burden decreased with increasing age and with decreasing eGFR, with patients >70 and with eGFR<30 having the lowest likelihood of survival with low AE burden (33%, Figure). Conclusion: Older LVAD recipients are less likely to have an optimal outcome at 3 years compared with younger patients, especially those patients with impaired renal function. Understanding the interaction between age and renal function on adverse outcomes will be important to optimizing patient selection for LVAD therapy. [Formula presented]

Volume

44

Issue

4

First Page

S447

Last Page

S448

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