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Updated: Mar 21, 2026
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
[Plasmatic pattern and clinical outcomes of lactic acid in heart transplantation]
Aníbal M Arias1, Vanina Leyendecker1, Rodolfo Pizarro1
1Servicio de Cardiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Insights
Elevated lactic acid levels post heart transplantation indicate higher in-hospital mortality risk. This finding is crucial for monitoring transplant recipients and improving patient outcomes in cardiac surgery.
Area of Science:
- Cardiology
- Transplantation Medicine
- Critical Care Medicine
Background:
- The prognostic significance of elevated lactic acid following heart transplantation remains unclear.
- Understanding lactate dynamics is essential for managing post-cardiac surgery patients.
Purpose of the Study:
- To investigate the plasma lactate pattern in heart transplant recipients.
- To determine the prognostic value of elevated lactate levels after heart transplantation.
Main Methods:
- A cohort study comparing 71 heart transplant patients with 56 coronary artery bypass graft (CABG) surgery patients (2011-2014).
- Lactic acid levels were measured pre-operatively, intra-operatively, and at 6, 12, and 24 hours post-operatively.
- Statistical analysis included univariate and bivariate assessments of lactate levels and in-hospital mortality in the transplant group.
Main Results:
- Heart transplant patients exhibited significantly higher intra-operative and post-operative lactic acid levels compared to the CABG control group.
- Elevated lactic acid levels at multiple time points (intra-operative, admission, post-admission) were significantly associated with in-hospital mortality in transplant recipients.
- Lactate at admission remained a significant predictor of mortality even after adjusting for factors like cardiac output, inotropic support, glycemic levels, age, and intra-operative time.
Conclusions:
- Heart transplant recipients demonstrate higher lactic acid levels compared to CABG patients.
- Post-transplant elevated lactic acid is a significant predictor of in-hospital mortality.
Introduction:
It is not well established the prognostic value of elevated lactic acid after heart transplantation.
Objective:
To evaluate the plasmatic pattern and the prognostic value of elevated lactate after heart transplantation.
Methods:
One-hundred and twenty seven patients were included between 2011 and 2014, 71 comprising the transplantation group and 56 the control group, represented by on pump coronary artery by-pass surgery patients. Lactic acid levels were compared between groups before, within and after surgery upon Coronary Care Unit admission, at 6, 12 and 24h. In addition, in the transplantation group univariate and bivariate analysis were performed between lactic acid levels and in-hospital mortality.
Results:
The mean age of the entire cohort was 57 years. Among transplanted patients, lactic acid levels were significantly higher over control group: within the surgery; and after surgery (P<.001), but not before surgery (P=.143; unadjusted comparisons). In transplanted patients, lactic acid levels were significantly associated with in-hospital mortality during surgery, at admission, and thereafter but not before surgery. Lactic acid at admission was associated with in-hospital mortality after adjustment of postoperative cardiac output (P=.011),≥2 inotropic drug support within 24h (P=.033), glycemic level at admission (P=.004), age≥60 years (P=.015), on pump time (P=.027), and pH (P=.017).
Conclusions:
Acid lactic levels were higher in transplanted patients than in the control group and was associated to higher in-hospital mortality.
