Pretransplant and perioperative predictors of early heart transplantation outcomes

• DOI: 10.3325/cmj.2014.55.553
• Publication Date: 2015-01-22T03:00:13Z
• Authors: Hrvoje Gašparović; Stjepan Ivanković; Jana Ljubas Maček; Filip Matovinović; Mislav Nedić; Lucija Svetina; Maja Čikes; Boško Skorić; Željko Baričević; Višnja Ivančan; Bojan Biočina; Davor Miličić
• Keywords: Adult; Graft Rejection; Male; Croatia; 610; /; Body Mass Index; Tertiary Care Centers; 03 medical and health sciences; 0302 clinical medicine; Lactates/blood; Risk Factors; Humans; Aged; Retrospective Studies; Heart Failure; Graft Rejection/prevention & control; Creatinine/blood; Middle Aged; Advanced Heart Failure; 3. Good health; Survival Rate; Treatment Outcome; Creatinine; Lactates; Heart Transplantation/mortality; Immunosuppressive Agents/therapeutic use; Heart Transplantation; Drug Therapy, Combination; Female; Heart Failure/surgery; Immunosuppressive Agents

Aim. To identify predictors of 3-month mortality after heart transplantation in a Croatian academic center. Methods. A retrospective review institutional database identified 117 transplantations from January 2008 to July 2014. Two children <14 years were excluded the study. The remaining 115 patients dichotomized into survivors and non-survivors adjudicated at 3-months postoperatively, their demographic, clinical, longitudinal hemodynamic data analyzed. Results. survival was 86%. Non-survivors older (59±8 vs 50±14 years, P=0.009), more likely have previous cardiac surgery (44% 19%; odds ratio [OR] 3.28, 95% confidence interval [CI] 1.08-9.90; P=0.029), lower body mass index (BMI) (25±4 28±2 kg/m(2), P=0.001), be diabetics 23%; OR 2.57, CI 0.86-7.66; P=0.083). Creatinine clearance marginally superior among (59=19 48 ± 20 mL/min, P=0.059). Donor age sex did not affect outcomes. had ischemic cardiomyopathy (69% 32%, P=0.010). Postoperative utilization epinephrine as second line inotropic agent strong predictor (63% 7%; 21.91; 6.15-78.06; P<0.001). Serum lactate concentrations consistently higher non-survivors, with difference being most pronounced 2 hours cardiopulmonary bypass (9.8±3.5 5.2±3.2 mmol/L, donor hearts exhibited inferior early hemodynamics (cardiac 3.0±1.0 4.0±1.1 L/min/m(2), stroke volume (49±24 59±19 mL, P=0.063), left right ventricular work indices (18±8 30±11 g/beat/m(2), P<0.001 5±3 7±4 P=0.060, respectively). require postoperative re-sternotomy (50% 12%; 7.25, 2.29-22.92; P<0.001), renal replacement therapy (RRT) 9%; 22.00, 6.24-77.54; mechanical circulatory assistance (MCS) 5%; 14.62, 3.84-55.62; Binary logistic regression revealed recipient (P=0.024), serum lactates CPB (P=0.007), use on day 1 (P=0.007) independently associated mortality. Conclusion. Pretransplant adverse outcome age, BMI, cardiomyopathy, reoperation diabetes. hemodynamics, use, concentrations. re-sternotomy, MCS, RRT.