Early Infection Risk Associated with Induction Immunosuppression after Cardiac Transplant in Patients with Left Ventricular Assist Devices

Purpose For patients with infected left ventricular support devices (LVADs) at the time of cardiac transplant, data on the risk of early infection and the effect of induction immunosuppression on post-transplant outcomes are limited. Methods In this retrospective cohort study from the UNOS database, we identified 9,294 bridge-to-transplant LVAD patients ≥18 years of age who received heart transplants between 2008 and 2018. Using propensity-scoring, 1,497 LVAD patients with device infection at the time of transplant were 1:1 matched to controls without device infection. Proportional hazards models were used to determine the effect of induction immunosuppression on outcomes including death/graft failure, infection, and acute rejection at 2 years post-transplant. Results Compared to patients without device infection, patients with infected LVADs had significantly higher rates of infection at 2 years post-transplant (22.2%, 95% CI 20.0%-24.7% versus 17.9%, 95% CI 15.8%-20.2%, P Conclusion For LVAD patients bridged to cardiac transplant, device infection at the time of transplant is a risk factor for post-transplant infection. However, it should not necessarily be considered a contraindication to receiving induction immunosuppression, which was not associated with increased incidence of adverse post-transplant outcomes.