Extreme Hyperlactatemia After Heart Transplantation: One Center's Experience

Area of Science:

• Cardiology
• Transplantation Medicine
• Critical Care Medicine

Background:

• Hyperlactatemia is a frequent early complication post-cardiac surgery, impacting patient prognosis.
• Extreme hyperlactatemia (>15 mmol/L) requires specific investigation in heart transplant recipients.

Purpose of the Study:

• To analyze perioperative variables and postoperative outcomes in heart transplant recipients with extreme hyperlactatemia (>15 mmol/L).

Main Methods:

• Retrospective review of 58 heart transplant recipients' medical records (June 2006 - May 2013).
• Analysis of patient characteristics, perioperative hemodynamics, arterial blood gas data, and postoperative mortality.
• Focus on patients with lactate levels exceeding 15 mmol/L post-intensive care unit admission.

Main Results:

• Twelve patients (20.7%) exhibited lactate levels >15 mmol/L post-ICU admission, peaking within 2 hours.
• Most patients (11/12) showed lactate normalization (<4 mmol/L) within 27.5 hours.
• Significant elevation in blood glucose levels observed concurrently with peak lactate.
• A trend towards delayed extubation was noted in 10 recipients (P < .01).
• Mortality occurred in 4 patients in ICU and 4 post-discharge; 6 survived over 1 year.

Conclusions:

• Extreme hyperlactatemia frequently occurs early after heart transplantation.
• Lactate levels typically normalize within 30 hours post-surgery.
• Delayed extubation is a significant postoperative outcome associated with extreme hyperlactatemia.