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Severe Postoperative Bleeding after Heart Transplantation.

Alexandre Mansour1, Adrien Bougle2, Marion Turpin3

  • 1Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Univ Rennes, CHU Rennes, CIC 1414 (Centre d'Investigation Clinique de Rennes), Inserm, IRSET, UMR_S 1085, FHU SUPORT, F35000 Rennes, France.

Anesthesiology
|January 13, 2026
PubMed
Summary

Severe bleeding complications occur in 25% of heart transplant recipients, increasing one-year mortality. Mechanical cardiac support and cardiopulmonary bypass duration are key risk factors for post-transplant bleeding.

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Area of Science:

  • Cardiology
  • Transplantation Surgery
  • Critical Care Medicine

Background:

  • Post-operative bleeding is a common concern in cardiac surgery.
  • However, its incidence, risk factors, and consequences after heart transplantation are not well-defined.
  • Severe bleeding complications significantly impact patient outcomes.

Purpose of the Study:

  • To determine the incidence of severe bleeding complications in adult heart transplant recipients.
  • To identify risk factors associated with severe post-operative bleeding.
  • To evaluate the impact of severe bleeding on one-year mortality.

Main Methods:

  • An observational study was conducted on adult heart transplant patients from 2015-2022 in two French centers.
  • Severe bleeding was defined using a Universal Definition of Perioperative Bleeding (UDPB) score ≥ 3.
  • Multivariable logistic and Cox regression models were used to identify risk factors and assess mortality impact.

Main Results:

  • Out of 446 patients, 112 (25%) experienced severe bleeding.
  • Risk factors included long-term mechanical cardiac support, lower preoperative hemoglobin, and longer cardiopulmonary bypass (CPB) duration.
  • Severe bleeding was linked to increased one-year mortality (35% vs. 13%, adjusted HR 1.91).

Conclusions:

  • The incidence of severe hemorrhagic complications after heart transplantation is high, especially in patients with mechanical circulatory support.
  • These bleeding events significantly increase patient morbidity and mortality.
  • Further research is needed to develop effective prevention strategies for post-heart transplant bleeding.