*Purpose: Our study examined the effect of intravenous (IV) ferric gluconate compared to oral iron repletion in reducing 30-day hospital readmissions and all-cause mortality in patients with left ventricular assist devices (LVAD) who received orthotopic heart transplants (OHT).

*Methods: This was a retrospective cohort study of patients bridged with LVAD (n=32) who received OHT at our institution from 2014 to 2019. LVAD patients with iron deficiency treated with IV ferric gluconate were compared to those receiving oral ferrous sulfate for one year following OHT or until death. Primary outcomes included one-year all-cause mortality and 30-day readmissions following OHT. Secondary outcomes included treated rejection, allograft dysfunction, cardiac allograft vasculopathy (CAV), CMV viremia, and gastrointestinal (GI) bleeding.

*Results: Prior to OHT, 5 LVAD patients received IV ferric gluconate compared to 27 patients who received oral iron. Baseline demographics were mostly similar between both groups (Table 1). One patient receiving IV iron therapy had higher requirement of blood product transfusions both pre and post OHT for GI bleeding. There was no difference in one-year survival, 30-day readmissions, treated rejection episodes, allograft dysfunction, CAV, CMV viremia and GI bleeding between the 2 groups.

*Conclusions: Intravenous ferric gluconate does not improve post heart transplant outcomes compared to oral iron therapy in LVAD patients. Prospective randomized controlled trials with larger sample sizes using other intravenous iron formulations such as ferric carboxymaltose may help clarify the role of intravenous iron therapy on post OHT outcomes in patients bridged with LVADs.

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