Pretransplant and perioperative predictors of early heart transplantation outcomes.

Gašparović, Hrvoje and Ivanković, Stjepan and Ljubas Maček, Jana and Matovinović, Filip and Nedić, Mislav and Svetina, Lucija and Čikeš, Maja and Skorić, Boško and Baričević, Željko and Ivančan, Višnja and Biočina, Bojan and Miličić, Davor (2014) Pretransplant and perioperative predictors of early heart transplantation outcomes. Croatian Medical Journal, 55 (6). pp. 553-61. ISSN 0353-9504

[img] PDF
Download (635kB)

Abstract

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

Abstract in Croatian

Predtransplantacijski i perioperativni prediktori ranih ishoda nakon presađivanja srca ----- Cilj: Odrediti prediktore tromjesečnog mortaliteta nakon presađivanja srca u jednom kliničkom bolničkom centru u Hrvatskoj. ----- Postupci: Retrospektivnim pregledom institucionalne baze podataka utvrdili smo da je između siječnja 2008. i lipnja 2014. presađivanje srca izvršeno kod 117 pacijenata. Dvoje djece mlađe od 14 godina isključeno je iz istraživanja Ostalih 115 pacijenata podijeljeno je na one koji su preživjeli prva 3 mjeseca nakon kirurškog zahvata i one koji nisu preživjeli. Analizirali smo njihove demografske, kliničke i dugoročne hemodinamičke podatke. ----- Rezultati: Tromjesečno preživljenje nakon presađivanja srca bilo je 86%. Pacijenti koji nisu preživjeli bili su stariji (59±8 vs 50±14 godina, P = 0,009), vjerojatnije su imali raniju operaciju srca (44% vs 19%; omjer izgleda [eng, odds ratio, OR] 3,28, 95% raspon pouzdanosti [eng, confidence interval, CI] 1,08-9,90; P = 0,029), imali su niži indeks tjelesne mase (25±4 vs 28±2 kg/m2, P = 0,001) i bili su dijabetičari (44% vs 23%; OR 2,57, 95% CI 0,86-7,66; P = 0,083). Klirens kreatinina bio je marginalno viši kod pacijenata koji su preživjeli (59±19 vs 48±20 mL/min, P = 0,059). Dob i spol davatelja nisu utjecali na ishode. Pacijenti koji nisu preživjeli vjerojatnije su ranije imali ishemijsku kardiomiopatiju (69% vs 32%, P = 0,010). Postoperativna uporaba epinefrina kao inotropnog agenta druge linije bila je snažan prediktor mortaliteta (63% vs 7%; OR 21,91; 95% CI 6,15-78,06; P < 0,001). Koncentracije serumskog laktata bile su dosljedno više među pacijentima koji nisu preživjeli, a razlika je bila najizraženija 2 sata nakon ugradnje kardiopulmonalne premosnice (9,8±3.5 vs 5.2±3,2 mmol/L, P < 0,001). Srca davatelja imala su lošija rana hemodinamička obilježja kod pacijenata koji nisu preživjeli – srčani indeks (3.0±1,0 vs 4,0±1.1 L/min/m2, P = 0,001), udarni volumen (49±24 vs 59±19 mL, P = 0,063) i indeks udarnog rada lijeve i desne klijetke (18±8 vs 30±11 g/otkucaju/m2, P < 0,001 odnosno 5±3 vs 7±4 g/otkucaju/m2, P = 0,060). Pacijenti koji nisu preživjeli vjerojatnije su trebali postoperativnu resternotomiju (50% vs 12%; OR 7.25, 95% CI 2,29-22,92; P < 0,001), nadoknadnu terapiju (69% vs 9%;OR 22,00, 95% CI 6,24-77,54; P < 0,001) i mehaničku krvotočnu potporu (44% vs 5%; OR 14,62, 95% CI 3,84-55,62; P < 0,001). Binarna logistička regresija pokazala ja da su dob primatelja (P = 0,024), razine serumskog laktata 2 sata nakon ugradnje kardiopulmonalne premosnice (P = 0,007) i uporaba epinefrina prvog postoperativnog dana bili neovisno povezani s tromjesečnim mortalitetom. ----- Zaključak: Predtransplantacijski prediktori nepovoljnog ishoda nakon presađivanja srca bili su dob primatelja, niži indeks tjelesne mase, ishemijska kardiomiopatija, naknadna operacija i dijabetes. Postoperativni prediktori mortaliteta bili su lošija hemodinamička obilježja srca davatelja, uporaba epinefrina i serumske koncentracije laktata. Pacijenti koji nisu preživjeli vjerojatnije su trebali resternotomiju, mehaničku krvotočnu potporu i nadoknadnu terapiju.

Item Type: Article
MeSH: Adult ; Aged ; Body Mass Index ; Creatinine/blood ; Croatia ; Drug Therapy, Combination ; Female ; Graft Rejection/prevention & control ; Heart Failure/surgery ; Heart Transplantation/mortality ; Humans ; Immunosuppressive Agents/therapeutic use ; Lactates/blood ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Survival Rate ; Tertiary Care Centers ; Treatment Outcome
Departments: Katedra za internu medicinu
Katedra za kirurgiju
Depositing User: Ana Babić
Status: Published
Creators:
CreatorsEmail
Gašparović, HrvojeUNSPECIFIED
Ivanković, StjepanUNSPECIFIED
Ljubas Maček, JanaUNSPECIFIED
Matovinović, FilipUNSPECIFIED
Nedić, MislavUNSPECIFIED
Svetina, LucijaUNSPECIFIED
Čikeš, MajaUNSPECIFIED
Skorić, BoškoUNSPECIFIED
Baričević, ŽeljkoUNSPECIFIED
Ivančan, VišnjaUNSPECIFIED
Biočina, BojanUNSPECIFIED
Miličić, DavorUNSPECIFIED
Date: December 2014
Date Deposited: 19 Feb 2016 13:24
Last Modified: 19 Feb 2016 13:24
Subjects: /
Related URLs:
URI: http://medlib.mef.hr/id/eprint/2476

Actions (login required)

View Item View Item

Downloads

Downloads per month over past year