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Do long-term results justify bridging to heart transplantation in patients with multi-organ dysfunction?
M Brandt1, M T Koch, G Steinhoff
1Department of Cardiovascular Surgery, University Hospital Kiel, Germany.
Insights
Heart transplantation outcomes are worse for patients with multi-organ dysfunction requiring invasive hemodynamic support. Early postoperative survival is significantly impacted, though long-term prognosis is similar for survivors. Improving organ function before transplant is crucial.
Area of Science:
- Cardiology
- Transplantation Surgery
- Critical Care Medicine
Background:
- Heart transplantation is a life-saving procedure for end-stage heart failure.
- Preoperative patient condition, including organ function and hemodynamic stability, significantly impacts post-transplant outcomes.
- Multi-organ dysfunction and the need for advanced hemodynamic support are critical factors influencing survival.
Purpose of the Study:
- To investigate the impact of multi-organ dysfunction on mortality after heart transplantation.
- To determine the influence of different types of preoperative hemodynamic support on heart transplant outcomes.
- To analyze early and long-term survival rates based on preoperative patient status.
Main Methods:
- Retrospective study of heart transplant recipients over a six-year period.
- Patients categorized into three groups based on hemodynamic support: stable oral medication, intravenous catecholamines, and mechanical support.
- Analysis of serum creatinine and transaminase levels to assess renal and hepatic function, correlated with survival data.
Main Results:
- Patients requiring intravenous catecholamines or mechanical support exhibited higher rates of renal and hepatic dysfunction.
- Early postoperative survival rates were significantly lower in groups requiring advanced hemodynamic support (Group B: 71%, Group C: 52%) compared to stable patients (Group A: 85%).
- In patients needing mechanical support, multi-organ dysfunction was associated with substantially worse prognosis (38% survival) versus those with normal organ function (75% survival).
Conclusions:
- Heart transplantation in patients with multi-organ dysfunction and on invasive hemodynamic support carries a significantly increased early postoperative risk.
- For recipients surviving the initial six months, long-term prognosis did not differ significantly between groups.
- Optimizing the condition of other organs, potentially through long-term mechanical support, is recommended before transplantation due to donor organ scarcity.
Abstract:
This retrospective study was performed to determine the influence of multi-organ dysfunction and the type of preoperative hemodynamic support on mortality after heart transplantation. All patients undergoing heart transplantation during a 6 year period were divided into 3 groups: group A patients (n = 110) had stable hemodynamics on oral medication, group B recipients (n = 41) received continuous i.v. catecholamine application, and in group C (n = 21) mechanical hemodynamic support was necessary. In groups B and C elevated serum creatinine and transaminase levels-reflecting renal and hepatic dysfunction-were detected more often and the survival rate was worse during the first six months (A: 85%, B: 71%, C: 52%, p < 0.01). In group C the prognosis of patients with multi-organ dysfunction was significantly worse compared to patients with normal renal and hepatic function (38% vs. 75%; p < 0.01). In recipients surviving for six months, there was no difference in long-term prognosis between the groups studied. It is concluded that heart transplantation in patients with multi-organ dysfunction on invasive hemodynamic support bears a significantly increased risk in the early postoperative period. In view of the current donor shortage the condition of other organs should be improved before transplantation as far as possible, even using long-term mechanical support.