Trends and Outcomes of Left Atrial Appendage Occlusion in Renal and Liver Transplant Recipients: Insights From the United States National Inpatient and Readmission Database

Left atrial appendage occlusion using the Watchman device has emerged as an alternative treat-ment strategy for preventing strokes in patients with atrial fibrillation. However, there is no data on its safety and clinical outcomes in prior renal or liver transplant recipients. We included a total of 61,995 patients from the National Inpatient Sample (NIS, in -hospital outcomes) and 55,048 patients from the National Readmission Database (NRD, 30-day out-comes) who underwent percutaneous left atrial appendage occlusion (LAAO). From this group, 0.65% (n=405) and 0.62% (n=339) were renal and liver trans-plant recipients in NIS and NRD respectively. Trans-plant recipients were younger compared with non -transplant recipients (mean age 69 vs 77 years, P=<0.01). There was little difference in terms of in -hospital mortality (0% vs 0.2%, P=0.43), major com-plications (6.2% vs 5.6%, P=0.61), cardiovascular complications (2.5% vs 2.8%, P=0.73), neurological complications (1.2% vs 0.7%, P=0.21) or bleeding complications (1.2% vs 0.7%, P=0.99) between trans-plant vs. non-transplant patients. Based on the NRD database, 30-day readmission rate was not meaning-fully different for transplant recipients undergoing LAAO (9.44%) when compared to non-transplant patients (8.12%, [log-rank, P=0.56]). There was no dif-ference between 30-day major or cardiovascular com-plications, however vascular complication rates were significantly higher for transplant recipients (OR 2.56, 95% CI [(1.66-3.47]). Our study findings suggest that LAAO may be safe for patients with a prior renal or liver transplant in terms of major complications, car-diovascular complications, and all-cause readmission rates. However vascular complications may be higher in transplant recipients. Further large-scale studies are needed to confirm these findings. (Curr Probl Car-diol 2023;48:101488.)