Related Experiment Videos
Determinants of hospital survival after cardiac transplantation
M Ibrahim1, R G Masters, P J Hendry
1University of Ottawa Heart Institute, Division of Cardiac Surgery, Ottawa Civic Hospital, Canada.
Insights
Preoperative mechanical support and immune suppression protocols significantly impact hospital survival after heart transplantation. Induction with immune globulin may reduce early mortality in transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunosuppression
Background:
- Heart transplantation is a critical treatment for end-stage heart failure.
- Identifying preoperative factors influencing early survival is essential for improving outcomes.
- Over 10 years, 183 transplantations were performed in 179 patients.
Purpose of the Study:
- To identify preoperative factors affecting hospital survival after heart transplantation.
- To analyze the impact of various clinical parameters on early post-transplant outcomes.
Main Methods:
- Retrospective analysis of 183 consecutive heart transplantations over a 10-year period.
- Univariate and multiple logistic regression analyses were used to assess survival determinants.
- Key factors analyzed included recipient diagnosis, prior operations, mechanical support, donor age, ischemic time, and immunosuppression protocols.
Main Results:
- Twenty-five hospital deaths occurred among 183 transplantations.
- Univariate analysis showed recipient diagnosis, mechanical support, donor age, and immunosuppression protocol influenced survival.
- Multiple logistic regression identified immune suppression induction method and preoperative mechanical support as significant independent determinants of survival.
Conclusions:
- Extended ischemic times and older donor age did not adversely affect early heart transplant success in this cohort.
- Induction with immune globulin appears to reduce early mortality.
- Patients requiring mechanical support pre-transplantation remain a significant challenge for early survival.
Abstract:
To identify the preoperative factors that influence hospital survival after transplantation we analyzed our consecutive experience of 183 transplantations in 179 patients over a 10-year period. There were 151 male and 29 female transplant recipients ranging in age from 10 days to 70 years (mean, 48 +/- 1 years). Diagnoses included coronary disease in 110 patients, cardiomyopathy in 55 patients, valvular disease in 6 patients, and congenital heart disease in 9 patients. Seventy-seven had undergone a previous cardiac operation, and 30 patients required preoperative mechanical support. Forty patients received hearts from donors who were 40 years old or older (range, 40 to 62 years). Ischemic time was greater than 240 minutes in 32 cases, and pulmonary vascular resistance was greater than 3 Wood units in 40 patients (range, 3.1 to 10.0 Wood units). Cyclosporine induction was used in 52 patients, whereas 128 recipients received polyclonal antibody prophylaxis. There were 25 hospital deaths. Recipient diagnosis, use of mechanical support, donor age, and the immune suppression protocol were related to hospital survival according to univariate analysis. Using multiple logistic regression, only the method of immune suppression induction and the use of mechanical assists were significant independent determinants of survival. In conclusion, we believe that extended ischemic times and donor age do not adversely affect the early success of transplantation, whereas induction with immune globulin may reduce early mortality. Patients requiring mechanical support before transplantation continue to be a challenge.