(1698) Comparing Pre-Heart Transplant Durable LVAD and Impella Use on Postoperative Kidney Outcomes

Introduction: It has been shown that kidney function can decline after heart transplant, and the renal effects of pretransplant use of mechanical circulatory support are not known. The objective of this study is to examine the effectiveness of durable left-ventricle assist device (LVAD) use compared to Impella use pre-heart transplant in terms of postoperative kidney outcomes.

Methods: This retrospective cohort study includes 131 patients who received heart transplants at Mayo Clinic between January 2021 and December 2023. Demographic characteristics of Impella and durable LVAD users including race, gender, age, primary heart failure etiology, body-mass index, and comorbidities were obtained from medical records and analyzed. Postoperative kidney outcomes were also analyzed.

Results: The cohort consists of 100 males and 31 females. A total of 99 patients used Impella pre- transplant and 32 used a durable LVAD. The median age at transplant was 57 and the most common heart failure etiology was dilated cardiomyopathy (58% of cohort). Also, 66% of durable LVAD users had chronic kidney disease (CKD) stage 3 or higher prior to transplant (21/32 patients), compared to 35% of Impella users (35/99 patients) (p=0.0016). Durable LVAD patients with CKD stage 3 (mean eGFR of 45 mL/min/1.73m2) (n=15) were noted to have a significant decline in kidney function at 1-month post-transplant (mean eGFR 37 mL/min/1.73m2) contrasted with Impella patients who had CKD stage 3 (mean preoperative eGFR of 45 mL/min/1.73m2) (n=42) with a 1-month post-transplant mean eGFR of 48 mL/min/1.73m2 (p=0.026). Durable LVAD users also had a significantly higher frequency of dialysis dependence post-transplant (9/32 patients, 26.7%) compared to Impella users (7/99 patients, 7.1%) (p=0.012).

Conclusions: Prevalence of CKD was higher in patients who received a durable LVAD pre-transplant compared to Impella. Frequency of dialysis dependence post-transplant was higher in patients who received durable LVADs pre-transplant. For patients with CKD, Impella use pre-transplant better preserved eGFR compared to durable LVAD use. Future studies with larger sample sizes are needed to further show improved postoperative kidney outcomes with Impella use compared to durable LVAD use.