Days Alive and Out of the Hospital After Heart Transplantation: A Retrospective Cohort Study.

Objective: Evaluate days alive and out of the hospital (DAOH) as an outcome measure after orthotopic heart transplantation in patients with mechanical circulatory support (MCS) as a bridge to transplant compared to those patients without prior MCS.

Design: A retrospective observational study of adult patients who underwent cardiac transplantation between January 1, 2015, and January 1, 2020. The primary outcome was DAOH at 365 days (DAOH) after an orthotopic heart transplant. A Poisson regression model was fitted to detect the association between independent variables and DAOH.

Setting: An academic tertiary referral center.

Participants: A total of 235 heart transplant patients were included-103 MCS as a bridge to transplant patients, and 132 direct orthotopic heart transplants without prior MCS.

Measurements And Main Results: The median DAOH for the entire cohort was 348 days (IQR 335.0-354.0). There was no difference in DAOH between the MCS patients and patients without MCS (347.0 days [IQR 336.0-353.0] v 348.0 days [IQR 334.0-354.0], p = 0.43). Multivariate analysis identified patients who underwent a transplant after the 2018 heart transplant allocation change, pretransplant pulmonary hypertension, and increased total ischemic time as predictors of reduced DAOH.

Conclusions: In this analysis of patients undergoing orthotopic heart transplantation, there was no significant difference in DAOH in patients with prior MCS as a bridge to transplant compared to those without MCS. Incorporating days alive and out of the hospital into the pre-transplant evaluation may improve understanding and conceptualization of the post-transplantation patient experience and aid in shared decision-making with clinicians.