Background: Ventricular assist device (VAD) is a valuable option for patients with heart failure awaiting heart transplantation (HTx), although the relatively high incidence of VAD infection can be life-threatening. There are few data regarding the incidence of post-transplant infections in patients with VAD pre-transplant as compared to those without VAD.

Methods: HTx recipients included in the Swiss Transplant Cohort Study between 5/2008 and 12/2011 were analyzed. Cumulative incidence curves were used to calculate the incidence of infection and mortality after transplant. Cox regression models treating death as competing risk were used to identify risk factors for the development of infection after transplant.

Results: 118 HTx were performed, 31 with a VAD and 87 without VAD. Mean age 47y, 80% males, 17% diabetes. Completed post-transplant follow-up (>6 months) was available for 87 patients (VAD=24, no VAD=63). In VAD patients, 12 (50%) presented at least one pre-transplant VAD-associated or related infection. Baseline characteristics were similar between VAD and no VAD groups. Mean number of post transplant bacterial/candida infection per patient was 0.75 for patients with VAD and 0.86 for those without VAD (p=0.73). In multivariate analysis, the absence of cotrimoxazole prophylaxis was the only risk factor associated with bacterial/candida infection post transplant (HR 0.19, p<0.001), but VAD was not (HR 1.21, p=0.65). There was no influence of VAD on the incidence of other fungal (HR 0.22, p=0.11) or viral (HR 1.29, p=0.44) infections. Overall mortality was 16.7% (4/24) in VAD group and 17.5% (11/63) in no VAD group (p=0.93). In VAD patients, mortality was not influenced by the presence of a pre transplant VAD infection (HR 1.25, p=0.88).

Conclusion: The presence of VAD at the time of transplant had no influence on the development of post transplant infections and on mortality. Infection of VAD should not be a contraindication for HTx.

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