The following is the summary of “National outcomes of bridge to multiorgan cardiac transplantation using mechanical circulatory support” published in the January 2023 issue of Thoracic and cardiovascular surgery by Melehy, et al.
Patients with multiorgan failure waiting for a heart transplant and another organ are a mysterious bunch. However, there is a lack of data on the transitional period during which these patients are supported by mechanical circulatory devices (MCS). In this analysis, researchers compared the results of bridging with and without MCS for patients waiting for multiorgan transplants from a nationwide database. For this study, investigators analyzed data on adult multiorgan transplants from 1986 to 2019 from the United Network for Organ Sharing. Patients who had had transplants and all those on the waiting list were analyzed and divided into groups based on their MCS status. In the post-transplant cohort, survival was analyzed using Cox regression, while in the waitlist cohort, survival was analyzed using Fine-Gray competing risk regression, where transplantation was included as a competing risk.
There were 4,534 waiting patients for multiorgan transplants during the research period, of whom 2,117 received multiorgan transplants. When looking at the entire cohort and the heart-kidney subgroup, there was no statistically significant difference in post-transplant survival between the MCS types and those without MCS. When comparing patients with and without MCS, Fine-Gray competing risk regression found that those who were bridged with extracorporeal membrane oxygenation had a higher risk of dying while waiting for surgery (subdistribution hazard ratio, 2.27; 95% CI, 1.48-3.47; P<.001), while those who were bridged with a ventricular assist device had a lower risk of dying while waiting for surgery (subdistribution hazard ratio, 0.78);
The present implementation of MCS does not negatively impact the survival of patients who have undergone a multiorgan heart transplant. Survival rates for patients requiring extracorporeal membrane oxygenation are drastically lower compared than those requiring conventional ventilation, which regardless of preoperative variables or the kind of organ mentioned. Waitlist survival rates for multi-organ transplants have increased throughout the years.