Follow-Up of Lung and Heart Transplant Recipients with Pre-Transplant Malignancies

on post transplant survival of patients (pts) bridged to transplant. Methods and Materials: 490 pts were implanted with HeartMate II LVAD in the multicenter BTT clinical trial. 416/490 (85%) had TPG data available for analysis. TPG was calculated as the difference between mean pulmonary arterial pressure and pulmonary capillary wedge. Pts were divided into two groups based on the median TPG value. Results: The median TPG of all pts was 10 mmHg. Pts age (50 13 vs. 51 12), sex, co morbidities, renal and hepatic function, and pre-HTX LVAD support times (239 264 days vs. 262 264 days) did not differ between groups. Overall, there were no differences in LVAD outcomes (Recovery, HTX, or ongoing support) for pts below median TPG ( 10 mmHg) and those above median TPG ( 10 mmHg). However, one year post HTX survival for pts with TPG below the median value ( 10 mmHg) was significantly higher (94%) than for those patients with TPG 10 mmHg (82%) (p 0.006). Analysis based on median PVR of 2.69 or upper quartile PVR of 3.8 did not reveal any differences between LVAD outcome of the groups or their post HTX survival. (91% vs 86% p 0.308, and 90% vs 84% p 0.3 respectively). Conclusions: Elevated TPG prior to LVAD implantation rather than high PVR, is associated with worse 1-year survival in HTX recipients. Elevated TPG appears as an important risk factor for post HTX mortality and therefore should be taken into consideration when contemplating heart transplant versus LVAD destination therapy in patients with advanced CHF.