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Intraoperative hemoglobin level and primary graft dysfunction in adult heart transplantation
Yuki Nakamura1, Shunsuke Saito1, Shigeru Miyagawa1
1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita City, Osaka, 565-0871, Japan.
Insights
Low recipient serum hemoglobin at donor heart reperfusion is linked to primary graft dysfunction after heart transplantation. Maintaining adequate hemoglobin levels may help prevent this complication.
Area of Science:
- Cardiology
- Transplantation Medicine
- Hematology
Background:
- Primary graft dysfunction (PGD) is a significant complication following heart transplantation.
- Recipient hemoglobin levels may influence PGD development, but evidence is limited.
Purpose of the Study:
- To investigate the association between recipient serum hemoglobin levels at donor heart reperfusion and the incidence of PGD.
- To determine if pre-transplant hemoglobin levels are associated with PGD.
Main Methods:
- Retrospective analysis of adult heart transplant recipients (2007-2016).
- Patients stratified into three quantiles based on serum hemoglobin at donor heart reperfusion.
- PGD incidence analyzed across hemoglobin quantiles.
Main Results:
- Of 69 patients, 12 developed PGD.
- Low hemoglobin at reperfusion (7.6 ± 0.9 mg/dL) was associated with significantly higher odds of PGD (OR 5.80; p < 0.001) compared to high hemoglobin (reference).
- No significant association found between pre-transplant hemoglobin levels and PGD.
Conclusions:
- Low recipient serum hemoglobin at donor heart reperfusion is an independent risk factor for PGD after heart transplantation.
- Intraoperative management of recipient hemoglobin, potentially via red blood cell transfusion, may be a strategy to prevent PGD.
Objectives:
We investigated the association between recipient serum hemoglobin and primary graft dysfunction after heart transplantation.
Methods:
We retrospectively evaluated adult patients who underwent heart transplantation at our institution from 2007 to 2016. Patients were grouped into three quantiles based on serum hemoglobin level at the time of donor heart reperfusion. Primary graft dysfunction was analyzed in each quantile.
Results:
We assessed 69 patients, and 12 showed primary graft dysfunction. The mean hemoglobin levels at reperfusion in the low, middle, and high hemoglobin quantiles were 7.6 ± 0.9, 9.2 ± 0.3, and 10.4 ± 0.6 mg/dL, respectively. There were no significant between-group differences in pre-heart transplantation serum hemoglobin levels (p = 0.53). The odds ratio for primary graft dysfunction was significantly higher in the low hemoglobin quantile (5.80; 95% confidence interval, 2.32-14.5; p < 0.001) than in the middle (1.14; 95% confidence interval, 0.40-3.23) and high (reference) hemoglobin quantiles. The odds ratios for primary graft dysfunction in the three quantiles based on pre-heart transplantation hemoglobin levels did not differ significantly.
Conclusions:
Low recipient serum hemoglobin levels at the time of donor heart reperfusion was independently associated with primary graft dysfunction after heart transplantation. Intraoperative management of recipient hemoglobin using red blood cell transfusion may prevent post-heart transplantation primary graft dysfunction.
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