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Multiorgan failure and in-hospital mortality in urgent heart transplantation: the PRESAGIO study
Raquel López-Vilella1, Francisco González-Vílchez2, Daniel Enríquez Vázquez3
1Unidad de Insuficiencia Cardiaca y Trasplante, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
Insights
In urgent heart transplantation (HT), prolonged mechanical ventilation (MV) and higher Sequential Organ Failure Assessment (SOFA) scores at the time of transplant are linked to increased in-hospital mortality (IHM). These factors are critical for predicting outcomes in high-risk HT candidates.
Area of Science:
- Cardiology
- Transplantation Medicine
- Critical Care Medicine
Background:
- Multiorgan failure is a contraindication for heart transplantation (HT).
- Standardized criteria for multiorgan failure definition exist in Spain.
- Analyzing these criteria's association with in-hospital mortality (IHM) is crucial for urgent HT candidates.
Purpose of the Study:
- To assess the association between multiorgan failure criteria at urgent HT listing and at transplantation, and in-hospital mortality (IHM).
- To evaluate the predictive value of Sequential Organ Failure Assessment (SOFA) scores and mechanical ventilation (MV) duration on IHM in HT recipients.
Main Methods:
- Ambispective multicenter study of urgent HT procedures (January 2020 - May 2024).
- Exclusion of patients <17 years, multiorgan transplants, and retransplants (n=328).
- Analysis of SOFA score, renal replacement therapy, MV, myopathy (MRC scale), and vasoactive-inotropic score (VIS) at listing and transplant.
Main Results:
- A reduction in SOFA scores was observed during the waiting period (P < .001).
- Myopathy worsened during the waiting period (3.7% increase in MRC < 36; P = .003).
- IHM associated with MV duration at inclusion (OR 1.05) and transplant (OR 1.03), and SOFA score 6-11 at transplant (OR 2.13).
Conclusions:
- Mechanical ventilation (MV) and higher SOFA scores at the time of transplantation are significant predictors of increased IHM in urgent HT.
- These findings highlight the importance of reassessing organ support status immediately prior to transplantation.
Introduction And Objectives:
Multiorgan failure is a contraindication to heart transplantation (HT). In Spain, standardized criteria have been established for its definition. The aim of this study was to analyze the association between these criteria, assessed at urgent waiting list inclusion and at the time of transplantation, and in-hospital mortality (IHM).
Methods:
Ambispective multicenter study of consecutive urgent HT procedures performed between January 2020 and May 2024. We excluded patients aged <17 years, those with multiorgan transplants, and retransplant recipients (n=328). Data from the Spanish Heart Transplant Registry and the following multiorgan failure-related variables, collected at both time points, were analyzed: Sequential Organ Failure Assessment (SOFA) score, renal replacement therapy, mechanical ventilation (MV), myopathy (Medical Research Council [MRC] scale), and vasoactive-inotropic score (VIS).
Results:
At inclusion, 62.5% of the patients had a SOFA score of 0-5 and 3.4%> 11; at transplantation, these proportions were 69.2% and 4.0%, respectively, with a reduction in SOFA score during the waiting period (P <.001). Eighty percent of patients did not require MV at either time point, and 10.3% received MV for> 7 days at transplantation. Myopathy worsened during the waiting period, with a 3.7% increase in patients with MRC <36 (P=.003), with no changes in VIS (P=.230). IHM was associated with duration of MV at inclusion (OR, 1.05; 95%CI, 1.01-1.10; P=.030) and at transplantation (OR, 1.03; 95%CI, 1.00-1.07; P=.050), and with a SOFA score of 6-11 (vs 0-5) at the time of transplantation (OR, 2.13; 95%CI, 1.03-4.38; P=.040).
Conclusions:
In urgent HT, MV and higher SOFA scores at the time of transplantation are associated with increased IHM.
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