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The Impact of Pre-Heart Transplantation Blood Transfusion Varies Based on Recipient MELD-XI Score
Taylor Nordan1, Hansuh H Lee, Frederick Y Chen
1From the Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Massachusetts.
Insights
Blood transfusions negatively impact heart transplant outcomes, particularly for patients with higher Model for End-Stage Liver Disease excluding INR (MELD-XI) scores. This study highlights increased mortality and longer hospital stays in these high-risk heart transplant recipients receiving transfusions.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Hematology
Background:
- Previous research indicates adverse effects of blood transfusions in cardiac surgery.
- The impact of transfusions on heart transplantation outcomes remains less understood.
- Patient stratification based on disease severity is crucial for understanding transfusion risks.
Purpose of the Study:
- To investigate the association between blood transfusions and outcomes in adult heart transplant recipients.
- To analyze the influence of pre-transplant disease severity, specifically the Model for End-Stage Liver Disease excluding INR (MELD-XI) score, on transfusion-related risks.
- To evaluate post-transplant mortality, length of stay, and need for dialysis in relation to transfusion status.
Main Methods:
- Retrospective analysis of first-time, single-organ adult heart transplant recipients from 2010-2020.
- Patients were stratified by MELD-XI score (≥9.4 vs. <9.4) and propensity score matched.
- A 90-day landmark analysis was conducted to assess survival differences.
Main Results:
- In recipients with MELD-XI ≥9.4, transfusion was associated with increased 90-day post-heart transplant mortality (adjusted HR 1.211, p < 0.001).
- Transfused patients with MELD-XI ≥9.4 experienced longer post-transplant hospital stays (25.9 vs. 23.2 days, p < 0.001) and higher rates of dialysis (18.7% vs. 15.9%, p = 0.009).
- No significant survival difference was observed in recipients with MELD-XI <9.4, regardless of transfusion status, after multivariable adjustment and propensity-score matching.
Conclusions:
- Blood transfusion is linked to worse outcomes, including higher mortality and morbidity, in heart transplant recipients with a MELD-XI score of 9.4 or higher.
- The findings suggest that careful consideration of transfusion strategies is warranted for high-risk heart transplant candidates.
- Further research may explore mechanisms underlying transfusion-related adverse effects in this vulnerable population.
Abstract:
Prior studies reveal adverse effects of transfusion on cardiac surgery, but little is known of transfusion impact on heart transplantation. First-time, single-organ adult heart transplant recipients between January 1, 2010, and December 31, 2020, were included, stratified above or below a model for end-stage liver disease excluding international normalized ratio (MELD-XI) score of 9.4, and propensity score matched to their nearest neighbor. A 90 day landmark analysis within each cohort was also performed. Unadjusted analysis showed transfusion recipients, MELD-XI ≥9.4, were more likely to experience post-heart transplantation mortality (Hazard Ratio (HR), 1.352 [95% Confidence Interval (CI), 1.239-1.477], p < 0.001), persisting after adjustment for potential confounders (adjusted HR, 1.211 [95% CI, 1.100-1.335], p < 0.001) and after propensity-score matching (HR, 1.174 [95% CI, 1.045-1.319], p = 0.007). Post-transplant length of stay was longer (25.9 vs. 23.2 days, p < 0.001). Post-transplant dialysis was more common (18.7 vs. 15.9%, p = 0.009). There was no survival difference on 90 day landmarked analysis ( p = 0.108). With MELD-XI <9.4, there was slight survival detriment among transfusion recipients on univariable analysis (HR, 1.111 [95% CI, 1.001-1.234], p = 0.049) but not on multivariable analysis (adjusted HR, 1.061 [95% CI, 0.952-1.181], p = 0.285). There was similar survival after propensity-score matching (HR, 1.032 [95% CI, 0.903-1.180], p = 0.642) and on landmark analysis ( p = 0.581). Ultimately, transfusion was associated with worse post-heart transplantation outcomes among recipients with a MELD-XI ≥9.4.
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