Effect of Blood Product Transfusion on Perioperative Outcomes After Heart Transplantation

Subramaniam, Kathirvel; Kumar, Akshay; Hernández, Sergio; Nouraie, Mehdi

doi:10.1053/j.jvca.2020.10.024

Cited by 16 publications

(8 citation statements)

References 20 publications

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“…Prior studies found that increased perioperative blood transfusion was independently associated with major adverse events in patients undergoing heart transplantation. 27,28 The reduced blood product needs associated with the use of SherpaPak system is an important finding, which possibly also contributed to the excellent outcomes observed in this study.…”

Section: Discussionmentioning

confidence: 66%

Outcomes of Heart Transplantation Using a Temperature-controlled Hypothermic Storage System

Zhu

Shudo

et al. 2023

Transplantation

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Background. The SherpaPak Cardiac Transport System is a novel technology that provides stable, optimal hypothermic control during organ transport. The objectives of this study were to describe our experience using the SherpaPak system and to compare outcomes after heart transplantation after using SherpaPak versus the conventional static cold storage method (non-SherpaPak). Methods. From 2018 to June 2021, 62 SherpaPak and 186 non-SherpaPak patients underwent primary heart transplantation at Stanford University with follow-up through May 2022. The primary end point was all-cause mortality, and secondary end points were postoperative complications. Optimal variable ratio matching, cox proportional hazards regression model, and Kaplan-Meier survival analyses were performed. Results. Before matching, the SherpaPak versus non-SherpaPak patients were older and received organs with significantly longer total allograft ischemic time. After matching, SherpaPak patients required fewer units of blood product for perioperative transfusion compared with non-SherpaPak patients but otherwise had similar postoperative outcomes such as hospital length of stay, primary graft dysfunction, inotrope score, mechanical circulatory support use, cerebral vascular accident, myocardial infarction, respiratory failure, new renal failure requiring dialysis, postoperative bleeding or tamponade requiring reoperation, infection, and survival. Conclusions. In conclusion, this is one of the first retrospective comparison studies that evaluated the outcomes of heart transplantation using organs preserved and transported via the SherpaPak system. Given the excellent outcomes, despite prolonged total allograft ischemic time, it may be reasonable to adopt the SherpaPak system to accept organs from a remote location to further expand the donor pool.

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Section: Discussionmentioning

confidence: 66%

Outcomes of Heart Transplantation Using a Temperature-controlled Hypothermic Storage System

Zhu

Shudo

et al. 2023

Transplantation

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“…This study also found that every 100 mL of RBC transfusion during the intraoperative period was associated with 1.1 increase in odds for severe PGD. This observation was echoed in a study by Subramaniam et al, 22 which found that RBC transfusion during the intraoperative and first 24 h after heart transplantation was associated with increased odds for graft dysfunction requiring mechanical circulatory support, renal dysfunction requiring renal replacement therapy, and 30-d mortality. An analysis by Howard-Quijano et al 23 found a dose-dependent relationship between RBC transfusion and postoperative inotrope score among a group of pediatric heart transplant recipients.…”

Section: Discussionmentioning

confidence: 90%

The Interaction of Amiodarone and Continuous-flow Left Ventricular Assist Device Use in Risk of Severe Primary Graft Dysfunction Following Heart Transplantation

Chinnadurai

Patel

Saeed

et al. 2022

Transplantation Direct

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“…The surgery time was significantly longer in Group A. Group A had higher RBC, platelets, and plasma transfusion than Group B. Subramaniam et al (26) reported that intra-and postoperative RBC transfusions (within the first 24 h) were associated with poor outcomes. The CRRT rate was relatively high in Group A; considering that both groups had similar rates of preoperative renal disease, the decrease in renal perfusion might have led to higher rates of CRRT use.…”

Section: Discussionmentioning

confidence: 96%

Donor/recipient ascending aortic diameter ratio as a novel potential metric for donor selection and improved clinical outcomes in heart transplantation: a propensity score-matched study

Masroor,

Chen,

Wang

et al. 2023

Front. Cardiovasc. Med.

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BackgroundDonor/recipient size matching is paramount in heart transplantation. Body weight, height, body mass index, body surface area, and predicted heart mass (PHM) ratios are generally used in size matching. Precise size matching is important to achieve better clinical outcomes. This study aims to determine the donor/recipient ascending aortic diameter (AAoD) ratio as a metric for donor selection and its effect on postoperative clinical outcomes in heart transplant patients.MethodsWe retrospectively reviewed all consecutive patients who underwent heart transplantation from January 2015 to December 2018. A cutoff value of 0.8032 for the donor/recipient AAoD ratio (independent variable for the primary endpoint during unmatched cohort analysis) was determined for predicting in-hospital mortality. The patients were divided into two groups based on the cutoff value. Group A, AAoD < 0.8032 (n = 96), and Group B, AAoD > 0.8032 (n = 265). A propensity score-matched (PSM) study was performed to equalize the two groups comprising 77 patients each in terms of risk. A Cox regression model was developed to identify the independent preoperative variables affecting the primary end-point. The primary endpoint was all-cause in-hospital mortality.ResultsA total of 361 patients underwent heart transplantation during the given period. On the multivariate analysis, donor/recipient PHM ratio [HR 16.907, 95% confidence interval (CI) 1.535–186.246, P = 0.021], donor/recipient AAoD ratio < 0.8032 (HR 5.398, 95% CI 1.181–24.681, P = 0.030), and diabetes (HR 3.138, 95% CI 1.017–9.689, P = 0.047) were found to be independent predictors of in-hospital mortality. Group A had higher 3-year mortality than Group B (P = 0.022). The surgery time was longer and postoperative RBC, plasma, and platelets transfusion were higher in Group A (P < 0.05). Although not statistically significant the use of continuous renal replacement therapy (P = 0.054), and extracorporeal membrane oxygenation (P = 0.086), was realatively higher, and ventilation time (P = 0.079) was relatively longer in Group A.ConclusionsThe donor/recipient AAoD ratio is a potential metric for patient matching and postoperative outcomes in heart transplantation. A donor/recipient AAoD ratio > 0.8032 could improve post-heart transplantation outcomes and donor heart utilization.

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Effect of Blood Product Transfusion on Perioperative Outcomes After Heart Transplantation

Cited by 16 publications

References 20 publications

Outcomes of Heart Transplantation Using a Temperature-controlled Hypothermic Storage System

Outcomes of Heart Transplantation Using a Temperature-controlled Hypothermic Storage System

The Interaction of Amiodarone and Continuous-flow Left Ventricular Assist Device Use in Risk of Severe Primary Graft Dysfunction Following Heart Transplantation

Donor/recipient ascending aortic diameter ratio as a novel potential metric for donor selection and improved clinical outcomes in heart transplantation: a propensity score-matched study

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