Key result
LVAD bridge-to-transplant is linked to ~61% higher odds of post-transplant primary graft dysfunction.
Why the study?
Primary graft dysfunction is a major determinant of early morbidity and mortality after heart transplantation, and the impact of durable LVAD bridge-to-transplant therapy on PGD risk had not been clearly defined in contemporary practice.
Does the use of a durable left ventricular assist device as bridge-to-transplant therapy increase the risk of primary graft dysfunction in adult heart transplant recipients compared with medical management?
Meta-Analysis (n=58,383)
Does the use of a durable left ventricular assist device as bridge-to-transplant therapy increase the risk of primary graft dysfunction in adult heart transplant recipients compared with medical management?
In adult heart transplant recipients, bridging with a durable LVAD is associated with a 61% higher odds of developing primary graft dysfunction compared to medical management, with pre-transplant amiodarone exposure further increasing this risk.
Background Primary graft dysfunction (PGD) remains a major determinant of early morbidity and mortality following heart transplantation. Durable left ventricular assist devices (LVADs) are frequently used as bridge-to-transplant (BTT) therapy; however, their impact on PGD risk has not been clearly defined in contemporary practice. The aim of this systematic review and meta-analysis was to evaluate whether the use of LVAD as bridge-to-transplant therapy increases the risk of primary graft dysfunction in adult heart transplant recipients. Methods From inception to November 2025, a comprehensive search for prospective and retrospective studies in MEDLINE, Embase, Cochrane, and Google Scholar was conducted. Studies were included if they reported data on the Odds Ratio(OR) or the incidence of primary graft dysfunction in LVAD bridge to transplant patients. Data from each study were combined using the random-effects model. Results were expressed as odds ratio (OR) and incidence (%) with 95% confidence interval (CI). Result Nineteen observational studies encompassing 58,383 heart transplant recipients were included. Among 11,249 LVAD BTT patients from 17 studies, the pooled incidence of PGD was 14.1% (95% CI: 9.5%–19.5%). In comparative analyses of 14 studies (n = 16,722), LVAD BTT was associated with higher odds of PGD compared with medically managed recipients (OR 1.61, 95% CI: 1.20–2.15; I² = 66%). Meta-regression demonstrated a negative association between recipient ischemic cardiomyopathy and PGD incidence. An analysis of device types (HM3, HeartMate II, HVAD) showed differential results. Among LVAD-supported recipients, pre-transplant amiodarone use was associated with increased PGD risk (OR 2.37, 95% CI: 1.13–4.96). Conclusion In patients undergoing heart transplantation, LVAD bridge-to-transplant support is associated with a significantly increased risk of primary graft dysfunction. Modifiable factors, including pre-transplant amiodarone exposure, may further influence PGD risk in this population. These findings highlight the importance of individualized perioperative risk assessment and optimization in LVAD-supported transplant candidates.
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Phatinavin et al. (2026) conducted a meta-analysis in Adult heart transplantation / Primary graft dysfunction (n=58,383). Left ventricular assist device (LVAD) bridge-to-transplant therapy vs. Medically managed heart transplant recipients was evaluated on Primary graft dysfunction (PGD) (OR 1.61, 95% CI 1.20-2.15). LVAD bridge-to-transplant therapy was associated with higher odds of primary graft dysfunction compared with medical management (OR 1.61, 95% CI 1.20-2.15; pooled incidence 14.1%).
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