Truby, Lauren K.Moayedi, YasbanooSignorile, MarisaFan, SteveForoutan, FaridRoss, HeatherGuzmán-Bofarull, JoanLerman, Joseph B.DeVore, Adam D.Hall, Shelley A.Takeda, KojiChih, SharonRódenas-Alesina, EduardRivas-Lasarte, MercedesHan, JihoKim, G.Moayedifar, RoxanaCouto-Mallón, DavidLuikart, Helen I.Henricksen, Erik J.Sabatino, MarioTremblay-Gravel, MaximeNoly, Pierre EmmanuelMiller, Robert J.H.Potena, LucianoCrespo-Leiro, María GenerosaSegovia Cubero, JavierFarrero-Torres, MartaZuckermann, AndreasKhush, Kiran K.Farr, Maryjane A.2026-03-032026-03-032025-11-03Truby LK, Moayedi Y, Signorile M, Steve Fan CP, Foroutan F, Ross H, Guzman-Bofarull J, Lerman JB, DeVore AD, Hall S, Takeda K, Chih S, Rodenas-Alesina E, Rivas-Lasarte M, Han J, Kim G, Moayedifar R, Couto-Mallon D, Luikart H, Henricksen E, Sabatino M, Tremblay-Gravel M, Noly PE, Miller R, Potena L, Crespo-Leiro M, Segovia-Cubero J, Farrero M, Zuckermann A, Khush KK, Farr M. Primary graft dysfunction in patients supported with durable left ventricular assist devices before heart transplantation. JACC Heart Fail. 2025 Nov;13(11):102618.2213-1787https://hdl.handle.net/2183/47556Multicenter study[Abstract] Background: Previous single-center studies identified an association between pretransplant durable left ventricular assist device (LVAD) support and severe primary graft dysfunction (PGD) following heart transplantation (HT). Objectives: The current study leverages data from the International Consortium on PGD data to identify trends, quantify outcomes, and identify clinical risk factors of high-risk LVAD-supported patients. Methods: Clinical data and outcomes of interest, including severe PGD, were compared between patients with and without LVAD support at the time of HT. Among LVAD-supported patients, univariate and multivariable logistic regression analysis was performed on a priori defined variables to determine their association with severe PGD. Results: The final analysis included 4,125 transplant recipients from 14 HT centers, receiving donor hearts by the donation after brain death strategy, with 1,091 (26%) patients supported by LVADs before HT. A total of 365 patients (8.6%) developed severe PGD: 7.4% of those patients without LVAD support and 12.7% of those with LVAD support (P < 0.001). Mortality at 1 year was significantly lower among patients with severe PGD who were bridged to transplantation with a durable LVAD: 28.8% (95% CI: 22.0%-37.1%) vs 40.7% (95% CI: 34.6%-47.7%); log-rank P = 0.025). Risk factors for severe PGD among LVAD-supported patients included pre-HT creatinine, ratio of central venous pressure to pulmonary capillary wedge pressure (CVP/PCWP ratio), and overall donor ischemic time. Conclusions: HT recipients supported by durable LVADs before HT are at increased risk of PGD, but they experience less mortality associated with this post-transplant complication. Surrogates of venous congestion, including pre-HT creatinine and CVP/PCWP ratio, identify high-risk LVAD-supported patients.engAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/Heart transplantationLeft ventricular assist devicePrimary graft dysfunctionjournal articleembargoed access10.1016/J.JCHF.2025.102618