Infectious complications and transplant outcomes in durable left ventricular assist device patients receiving immunosuppressive therapy: case series

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Abstract
Background: The long-term prognosis of patients supported by durable left ventricular assist devices (LVAD) while receiving immunosuppressive therapy remains unclear. Underlying conditions such as cardiac sarcoidosis, recurrent myocarditis, or post-organ transplantation may necessitate concomitant immunosuppressive therapy during LVAD support. In particular, patients requiring prolonged immunosuppressive therapy exceeding low-dose corticosteroids represent a clinically challenging population in whom infectious complications and long-term outcomes have not been well characterized. Case summary: We retrospectively reviewed 241 consecutive LVAD recipients (HeartMate II and HeartMate 3) at a single centre (2013–24). Five patients (2.1%) required prolonged immunosuppressive therapy exceeding low-dose corticosteroids. Underlying cardiac conditions included myocarditis (n = 3), cardiac sarcoidosis (n = 1), and dilated cardiomyopathy following liver transplantation (n = 1). The mean duration of immunosuppressive therapy during LVAD support was 2.3 years (0.8–4.5 years). One patient developed LVAD-specific infections including driveline infection. Two underwent successful heart transplantation without perioperative complications. One was tapered to low-dose corticosteroid monotherapy due to a non-device-related infection, and two remained stable on LVAD support. Discussion: This case series underscores the complexity of managing LVAD patients requiring extended immunosuppressive therapy and highlights a unique and underreported patient population. Our findings suggest that successful heart transplantation may be achievable in immunosuppressed LVAD patients when supported by vigilant infection surveillance and individualized treatment strategies. This topic is of increasing clinical importance, particularly in regions where DT indications have recently been expanded.

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