(1786) Heart Transplant Showdown: Impella Versus No MCS for Kidney Health

Introduction: The Impella is a medical device often used as a bridge to heart transplant. Understanding its long-term impact on renal function is crucial, as kidney health has a critical role in overall patient outcomes. Our aim is to study the influence of Impella on kidney function post-transplant by comparing postoperative estimated glomerular filtration rate (eGFR) and the need for renal replacement therapy (RRT) compared to patients without Mechanical Circulatory Support (MCS).

Methods: This retrospective, IRB-approved study evaluated a cohort of 225 heart transplant patients across three Mayo Clinic sites from January 2021 to December 2023. We collected baseline eGFR from hospital admissions and documented the use of Impella (Types C.P, 5.0 and 5.5) prior to transplantation. Post-transplant data included the need for RRT and eGFR values at 1 month, 6 months, and 1 year. Outcomes for Impella patients were compared with those of patients who didn’t receive any MCS.

Results: Our study cohort consisted of 225 patients, with 157 males (69.7%), predominantly Caucasian (80.44%), and a mean age of 52 (±14) years. Of these, 73 patients (32.4%) received Impella support, while 152 patients (67.6%) did not use any MCS. Among the Impella users, 70 (95.9%) used Impella 5,5. In patients with a preoperative eGFR of 30-60 mL/min/1.73m², Impella users showed a mean eGFR of 51.85 at 1 year, compared to 42.81 in patients without any Mechanical Circulatory Support (MCS) (p = 0.034). Additionally, Impella use was associated with a longer overall hospital stay (p = 0.009) and extended ICU stay (p = 0.003) compared to patients without MCS. The mean post-transplant hospital stay for Impella users was 16 days, while it was 19 days for those without MCS (p = 0.037). RRT dependence was lower in the Impella group (p = 0.027).

Conclusions: The use of Impella as a bridge in heart transplant appears to be associated with improved long-term renal function and had a significantly reduced dependence on Renal Replacement Therapy. These findings are crucial for managing patients waiting for heart transplants and highlight the potential benefits of Impella.