Influence of Liver and Renal Impairments on Early Mortality in Heart Transplant Patients

• Published in: The Journal of heart and lung transplantation Vol. 32; no. 4; p. S52
• Main Authors: Lebray, P, Varnous, S, Leprince, P, Luyt, C.E, Rousseau, G, Pascale, A, Thabut, D, Ratziu, V, Vaillant, J.C, Chastre, J, Pavie, A
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2013
• Subjects: Surgery
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2013.01.937

Purpose Almost 25% of patients will die prematurely following heart transplantation (HT). No data is available about liver impairment previously to HT. Aim: To analyze the prevalence of liver and renal impairments at listing as factors of early failure following HT. Methods and Materials Retrospective data in successive patients listing for HT between 2004-2011 were analyzed. Exclusion criteria included combined transplantation (4) and histological cirrhosis (6). Uni and multivariate analysis with logistic regression provided an evaluation of risks factors for 3-months death following HT(M3 death). Results 385 patients were analyzed (77,6% male), 49±years-old, 35% redux, 49% UNOS I, 24% with ventricular assisted device (VAD). Four patients underwent dialysis. HT causes were: dilated cardiomyopathy (47%), coronaropathy (29%), hypertrophic or restrictive cardiomyopathy (5%), valvulopathy (4%), congenital or retransplantation (2% each). 11,8% patients died during waiting time. Among the 323 HT patients, 98 (30%) died before month 3. In univariate analysis, M3 death was associated notably with: bilirubinemia (27,5 vs. 17 μmol/l, p =0,001), creatininemia (129,5 vs.101,5 μmol/l, p=0,0007), AST (37 vs.33 UI/l, p=0,04), PAL (113,5 UI/l vs. 88, p=0,002), MELD score (16,1 vs. 11,7, p=7.10-6 ), clinical ascites (47 vs. 27, p=0,006) and right ventricular failure (36 vs. 19, p=0,03). No association was found with sex, blood group, age at listing, INR, CRP, redux, invasive ventilation, VAD, or vasopressive drugs. Logistic regression analysis only found ascitis (OR=0,26,p=0,04) and MELD score (OR=0,86, p=0,02) as independent variables at 3 months. Estimated logistic regression model with an area Under ROC Curve of 0,78 could correctly classify 79% of the patients. These 2 variables were not associated with waiting list mortality nor 1 year post-transplant survival. Conclusions In heart transplant candidates, liver and renal impairments characterized by MELD≥16 and ascitis are independant factors associated with early post-transplant mortality.