Outcome and Midterm Survival after Heart Transplantation Is Independent from Donor Length of Stay in the Intensive Care Unit
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethics
2.2. Recipients and Study Design
2.3. Data Collection
2.4. Statistical Analysis and Figure Making
3. Results
3.1. Recipient Data
3.2. Donor Data
3.3. Perioperative Morbidity
3.4. Survival
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Recipient Variables | All Patients | Gr 1 0–3 Days | Gr 2 4–7 Days | Gr 3 ≥8 Days | p | ||
---|---|---|---|---|---|---|---|
n = 241 | Total n = 92 | Total n = 80 | Total n = 69 | 1 vs. 2 | 1 vs. 3 | 2 vs. 3 | |
Age (y) | 58 (50–62) | 59 (51–62) | 57 (45–63) | 59 (53–63) | 0.18 | 0.47 | 0.06 |
Gender (% male) | 72.2 | 73.9 | 75.0 | 66.7 | >0.99 | 0.38 | 0.28 |
Height (cm) | 175 (169–180) | 175 (168–182) | 175 (170–180) | 173 (168–178) | 0.66 | 0.29 | 0.50 |
Weight (kg) | 78 (68–87) | 80 (69–90) | 79 (70–87) | 74 (65–83) | 0.95 | 0.06 | 0.07 |
Body mass index (kg/m2) | 25 (23–28) | 26 (23–29) | 26 (23–29) | 24 (21–28) | 0.82 | 0.10 | 0.09 |
Predicted heart mass ratio (%) | 0.98 (0.87–1.10) | 0.99 (0.89–1.07) | 0.98 (0.84–1.14) | 0.97 (0.88–1.12) | 0.71 | 0.47 | 0.76 |
Cardiac reoperation (%) | 63.1 | 62.0 | 65.0 | 62.3 | 0.75 | >0.99 | 0.86 |
High-urgency waiting list (%) | 44.8 | 37.0 | 48.8 | 50.7 | 0.13 | 0.11 | 0.87 |
Ventricular assist device (%) | 50.6 | 50.0 | 50.0 | 52.2 | >0.99 | 0.87 | 0.87 |
CPR pre HTx (%) | 7.3 | 13.0 | 10.1 | 15.9 | 0.72 | 0.83 | 0.27 |
Diabetes mellitus (%) | 22.6 | 17.6 | 24.1 | 27.5 | 0.34 | 0.18 | 0.71 |
Arterial hypertension (%) | 57.1 | 59.8 | 60.8 | 49.3 | >0.99 | 0.20 | 0.19 |
ICM (%) | 43.5 | 53.3 | 37.2 | 37.7 | 0.06 | 0.06 | >0.99 |
Pulmonary hypertension (%) | 9.1 | 12.0 | 8.9 | 5.8 | 0.62 | 0.27 | 0.54 |
PRA pre HTx (% as mean) | 2.33 (±13.7) | 0.82 (±5.2) | 3.8 (±19.3) | 2.63 (±13.5) | 0.18 | 0.30 | 0.68 |
PRA >10% pre HTx (n, %) | 7/241 (2.9 | 1/92 (1.1) | 3/80 (3.7) | 3/69 (4.3) | 0.34 | 0.31 | >0.99 |
Laboratory values | |||||||
Hemoglobin (g/dL) | 12 (10–14) | 12 (10–14) | 12 (10–14) | 12 (10–13) | 0.85 | 0.78 | 0.93 |
Creatinine (mg/dL) | 1.2 (1.0–1.6) | 1.2 (1.0–1.6) | 1.1 (1.0–1.5) | 1.2 (0.9–1.7) | 0.47 | 0.37 | 0.87 |
GFR pre HTx (mL/min) | 62 (45–82) | 63 (47–81) | 65 (48–81) | 60 (39–85) | 0.71 | 0.53 | 0.35 |
Bilirubin (mg/dL) | 0.6 (0.4–1.0) | 0.6 (0.4–1.0) | 0.6 (0.4–1.1) | 0.6 (0.4–1.0) | 0.37 | 0.48 | 0.86 |
Lactate dehydrogenase (U/L) | 254 (213–314) | 248 (212–307) | 259 (211–328) | 258 (224–316) | 0.47 | 0.44 | 0.14 |
Sodium (mmol/L) | 138 (136–141) | 139 (136–141) | 138 (136–140) | 138 (137–141) | 0.37 | 0.66 | 0.20 |
Potassium (mmol/L) | 4.3 (3.9–4.6) | 4.3 (3.9–4.6) | 4.3 (3.9–4.6) | 4.2 (3.9–4.6) | 0.25 | 0.25 | 0.99 |
Donor Variables | All Patients | Gr 1 0–3 Days | Gr 2 4–7 Days | Gr 3 ≥8 Days | p | ||
---|---|---|---|---|---|---|---|
n = 241 | Total n = 92 | Total n = 80 | Total n = 69 | 1 vs. 2 | 1 vs. 3 | 2 vs. 3 | |
Age (y) | 46 (35–53) | 43 (32–51) | 46 (33–54) | 46 (38–54) | 0.35 | 0.06 | 0.33 |
Gender (% male) | 54.8 | 57.6 | 57.5 | 47.8 | >0.99 | 0.26 | 0.25 |
Height (cm) | 175 (168–180) | 175 (170–183) | 175 (168–180) | 173 (166–180) | 0.43 | 0.09 | 0.35 |
Weight (kg) | 80 (70–85) | 80 (70–87) | 79 (70–85) | 75 (70–81) | 0.56 | 0.28 | 0.12 |
Body mass index (kg/m2) | 25 (23–28) | 26 (23–28) | 26 (23–29) | 25 (23–28) | 0.56 | 0.56 | 0.21 |
Left ventricular ejection fraction (%) | 60 (55–65) | 60 (55–62) | 61 (57–68) | 61 (55–65) | 0.31 | 0.31 | 0.32 |
CPR pre brain death (%) | 28.6 | 29.3 | 38.8 | 15.9 | 0.20 | 0.06 | 0.003 |
Donor duration on IMC/ICU (d) | 4 (3–8) | 2 (2–3) | 5 (4–5) | 12 (10–16) | <0.0001 | <0.0001 | <0.0001 |
Arterial hypertension (%) | 49.6 | 38.9 | 57.9 | 57.1 | 0.09 | 0.13 | >0.99 |
Diabetes mellitus (%) | 16.5 | 15.9 | 18.2 | 16.0 | >0.99 | >0.99 | >0.99 |
History of smoking (%) | 62.7 | 65.0 | 65.9 | 56.1 | >0.99 | 0.37 | 0.35 |
History of alcohol abuse (%) | 41.8 | 42.9 | 49.2 | 33.3 | 0.39 | 0.45 | 0.09 |
History of drug abuse (%) | 11.8 | 13.7 | 10.2 | 10.9 | 0.54 | 0.79 | >0.99 |
Norepinephrine, peak dose (µg/kg/min) | 0.12 (0.05–0.26) | 0.15 (0.05–0.28) | 0.11 (0.04–0.26) | 0.12 (0.05–0.24) | 0.79 | 0.16 | 0.33 |
Donor cause of death | |||||||
ICB (%) | 46.1 | 50.0 | 28.7 | 60.9 | 0.005 | 0.20 | 0.0001 |
Trauma (%) | 22.4 | 26.1 | 26.3 | 13.0 | >0.99 | 0.05 | 0.06 |
Hypoxic (%) | 16.2 | 15.2 | 20.0 | 13.0 | 0.43 | 0.82 | 0.28 |
Vascular (%) | 6.2 | 3.3 | 10.0 | 5.8 | 0.12 | 0.70 | 0.38 |
Other (%) | 9.1 | 5.4 | 15.0 | 7.2 | 0.12 | 0.18 | >0.99 |
Laboratory values | |||||||
White blood cell count, peak (109/L) | 18 (14–23) | 17 (13–23) | 18 (15–22) | 19 (14–23) | 0.29 | 0.70 | 0.34 |
C-reactive protein (mg/L) | 163 (63–249) | 118 (24–218) | 185 (103–259) | 187 (100–284) | 0.40 | 0.73 | 0.43 |
Hemoglobin (g/dL) | 10 (8–12) | 11 (8–14) | 10 (8–12) | 9 (8–10) | 0.12 | 0.00011 | 0.025 |
Lactate dehydrogenase (U/L) | 323 (238–531) | 300 (234–519) | 323 (248–509) | 333 (242–586) | 0.22 | 0.56 | 0.36 |
Sodium (mmol/L) | 149 (144–154) | 147 (142–151) | 153 (145–158) | 149 (143–154) | <0.0001 | 0.11 | 0.017 |
Potassium (mmol/L) | 4 (4–5) | 4 (4–5) | 4 (4–4) | 4 (4–4) | 0.14 | 0.64 | 0.25 |
Outcome and Survival | All Patients | Gr 1 0–3 Days | Gr 2 4–7 Days | Gr 3 ≥8 Days | p | ||
---|---|---|---|---|---|---|---|
n = 241 | Total n = 92 | Total n = 80 | Total n = 69 | 1 vs. 2 | 1 vs. 3 | 2 vs. 3 | |
Total graft ischemia time (min) | 213 (187–237) | 214 (193–242) | 215 (185–215) | 207 (176–207) | 0.41 | 0.24 | 0.72 |
Graft cold ischemia time (min) | 149 (127–172) | 151 (134–176) | 147 (119–147) | 148 (121–148) | 0.39 | 0.14 | 0.58 |
Postoperative hospital stay (d) | 36 (27–51) | 37 (26–48) | 34 (26–34) | 39 (28–39) | 0.32 | 0.41 | 0.08 |
Postoperative IMC/ICU stay (d) | 16 (10–28) | 17 (10–30) | 15 (10–15) | 16 (10–16) | 0.21 | 0.51 | 0.09 |
Mechanical ventilation (h) | 66 (25–175) | 92 (28–201) | 54 (26–54) | 51 (21–51) | 0.30 | 0.98 | 0.37 |
Duration of surgery (min) | 412 (339–505) | 415 (346–491) | 403 (333–403) | 411 (341–411) | 0.74 | 0.68 | 0.49 |
Blood transfusions surgery | |||||||
Packed red blood cells, ml | 2970 (1620–4590) | 2970 (1620–4455) | 2430 (1350–2430) | 3375 (1890–3375) | 0.69 | 0.49 | 0.29 |
Platelets, ml | 880 (660–1540) | 880 (660–1540) | 880 (660–880) | 880 (440–880) | 0.33 | 0.65 | 0.65 |
Fresh frozen plasma, ml | 1000 (0–2000) | 1250 (500–2125) | 1000 (0–1000) | 1250 (0–1250) | 0.20 | 0.80 | 0.35 |
Blood transfusions IMC/ICU | |||||||
Packed red blood cells, ml | 1890 (810–4320) | 1620 (810–4320) | 1890 (540–1890) | 2160 (810–2160) | 0.56 | 0.62 | 0.95 |
Platelets, ml | 220 (0–1100) | 220 (0–1100) | 220 (0–220) | 220 (0–220) | 0.44 | 0.18 | 0.54 |
Fresh frozen plasma, ml | 3500 (2000–6750) | 4250 (2250–8000) | 3000 (1750–3000) | 3500 (2000–3500) | 0.76 | 0.25 | 0.54 |
Postoperative morbidity | |||||||
Infection/sepsis (%) | 23.2 | 29.7 | 18.8 | 19.7 | 0.11 | 0.12 | >0.99 |
Rejection within stay (%) | 6.8 | 3.3 | 11.3 | 6.1 | 0.07 | 0.46 | 0.38 |
Hemodialysis post HTx (%) | 57.4 | 60.7 | 50.6 | 61.3 | 0.21 | >0.99 | 0.23 |
Neurological complications (%) | 14.8 | 13.2 | 12.5 | 19.7 | >0.99 | 0.38 | 0.26 |
Re-thoracotomy post HTx (%) | 30.0 | 29.7 | 28.8 | 31.8 | >0.99 | 0.86 | 0.72 |
ECLS post HTx (%) | 28.7 | 31.9 | 25.0 | 28.8 | 0.40 | 0.73 | 0.71 |
Survival | |||||||
30-day survival n (%) | 216/238 (91%) | 79/91 (87%) | 75/80 (94%) | 62/67 (93%) | 0.20 | 0.31 | >0.99 |
1-year survival n (%) | 161/203 (79%) | 61/78 (78%) | 57/69 (82%) | 43/56 (77%) | 0.54 | >0.99 | 0.51 |
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Oehler, D.; Böttger, C.; Immohr, M.B.; Bruno, R.R.; Haschemi, J.; Scheiber, D.; Horn, P.; Aubin, H.; Tudorache, I.; Westenfeld, R.; et al. Outcome and Midterm Survival after Heart Transplantation Is Independent from Donor Length of Stay in the Intensive Care Unit. Life 2022, 12, 1053. https://doi.org/10.3390/life12071053
Oehler D, Böttger C, Immohr MB, Bruno RR, Haschemi J, Scheiber D, Horn P, Aubin H, Tudorache I, Westenfeld R, et al. Outcome and Midterm Survival after Heart Transplantation Is Independent from Donor Length of Stay in the Intensive Care Unit. Life. 2022; 12(7):1053. https://doi.org/10.3390/life12071053
Chicago/Turabian StyleOehler, Daniel, Charlotte Böttger, Moritz Benjamin Immohr, Raphael Romano Bruno, Jafer Haschemi, Daniel Scheiber, Patrick Horn, Hug Aubin, Igor Tudorache, Ralf Westenfeld, and et al. 2022. "Outcome and Midterm Survival after Heart Transplantation Is Independent from Donor Length of Stay in the Intensive Care Unit" Life 12, no. 7: 1053. https://doi.org/10.3390/life12071053