SPC365

Heart transplant in acutely ill patients: time on waiting list and 1-year mortality

Session: SESSÃO DE POSTERS 22 - LVAD / TRANSPLANTAÇÃO CARDÍACA
Speaker: Ana Rita Bello

Congress: CPC 2025
Topic: D. Heart Failure
Theme: 11. Acute Heart Failure
Subtheme: 11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Cartazes
FP Number: ---
Authors: Ana Rita Bello; Rita Almeida Carvalho; Márcia Presume; Rita Amador; Sérgio Maltês; Bruno ML Rocha; Catarina Brízido; António Tralhão; Christopher Strong; Marta Marques; Carlos Aguiar

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Introduction:</span></strong><br />
<span style="font-family:&quot;Calibri&quot;,sans-serif">In selected advanced heart failure (HF) patients, heart transplant (HT) can improve both symptoms and prognosis. Improvements in HF therapy and the growing recognition of advanced HF, have led to an increasing number of HT candidates and longer waiting list times. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Objectives:</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">We aimed to assess waiting list times for HT, comparing different groups of severity of patients who underwent a HT, and the impact on patient outcomes.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods:</span></strong><br />
<span style="font-family:&quot;Calibri&quot;,sans-serif">This retrospective, single-center study included HT recipients from January 2018 to September 2024. Patients were classified according to their status before HT: outpatient setting (group A), admission due to acute HF (group B), and cardiogenic shock under short-term mechanical circulatory support (MCS) (group C). Demographic characteristics, waiting list times, and outcomes were compared using non-parametric analysis and Kaplan-Meier survival curves.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Results:</span></strong><br />
<span style="font-family:&quot;Calibri&quot;,sans-serif">A total of 76 patients were included (68% male), with a mean age of 50 years (&plusmn;11). The most common HF etiology was ischemic heart disease (39%). A total of 34 (45%) patients were in class INTERMACS 1-3. The cohort comprised 42 patients who were electively admitted for HT (4 under intermittent levosimendan, 7 with durable LVAD), 18 patients who underwent HT in the setting of acute decompensated HF (4 on intravenous furosemide, 5 on intermittent levosimendan, and 9 on continuous iv inotropes), and 16 patients who were being treated in the cardiac intensive care unit and required MCS at the time of HT (8 on VA-ECMO, 5 on BiVAD, 3 on IABP). In-hospital mortality during HT admission was 8% (6 patients). Overall survival after HT was 85% during the first 12 months.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">The median time on waiting list for HT was 128 days (IQR 63-314) for elective patients (group A), 26 days (IQR 12&ndash;128) for patients with acute HF (group B), and 7 days (IQR 3-17) for those dependent on short-term MCS (group C). Despite prolonged hospitalizations and a higher incidence of complications (including infections and ICU-acquired weakness, p=0.003), patients in groups B and C&nbsp;had similar 12-month survival compared with elective patients (log-rank 0.177, p=0.151) (Figure 1).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusion:</span></strong><br />
<span style="font-family:&quot;Calibri&quot;,sans-serif">Patients with advanced HF admitted for acute decompensation, with or without need for short-term MCS, had significantly shorter waiting list times compared with elective HT candidates. Despite having a higher complication burden during their admission, these patients had similar 12-month survival rates compared&nbsp;to those admitted electively for a HT.</span></span></span></p>