Multivariate Predictors of Heart Transplantation Outcomes in the Era of Chronic Mechanical Circulatory Support

Drakos, Stavros G.; Kfoury, Abdallah G.; Gilbert, Edward M.; Long, James W.; Stringham, James C.; Hammond, Elizabeth H.; Jones, Kent W.; Bull, David A.; Hagan, MaryBeth E.; Folsom, Jan W.; Horne, Benjamin D.; Renlund, Dale G.

doi:10.1016/j.athoracsur.2006.07.050

Cited by 25 publications

(16 citation statements)

References 18 publications

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“…18 In addition, some studies showed that predictors of poor outcome were similar in total artificial heart or biventricular VAD implantation as compared with VAD implantation. 19 -21 Several other scores addressed the prediction of right heart failure after VAD implantation 22,23 or outcome after heart transplantation in previous VADbridged patients, 24 or made use of existing intensive care scores, such as the APACHE II score, to predict VAD mortality. 25 However, these already existing scores, which attempt to predict mortality after VAD implantation by using pre-operative markers, have two major limitations.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative prediction of post–VAD implant mortality using easily accessible clinical parameters

Klotz

Vahlhaus

Riehl

et al. 2010

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 99%

Pre-operative prediction of post–VAD implant mortality using easily accessible clinical parameters

Klotz

Vahlhaus

Riehl

et al. 2010

The Journal of Heart and Lung Transplantation

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“…We are aware of a single publication reporting that prolonged postoperative intensive care unit stay was associated with renal dysfunction at 2 years . The influence of inotropes on post‐transplant kidney function has been evaluated in a number of studies, but conclusions are inconsistent .…”

Section: Discussionmentioning

confidence: 99%

Long-term evolution, secular trends, and risk factors of renal dysfunction following cardiac transplantation

et al. 2014

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SummaryRecent reports suggest that individuals who underwent heart transplantation in the last decade have improved post-transplant kidney function. The objectives of this retrospective study were to describe the incidence and to identify fixed and time-dependent predictors of renal dysfunction in cardiac recipients transplanted over a 25-year period (1983-2008). To illustrate temporal trends, patients (n = 306) were divided into five groups based on year of transplantation. The primary endpoint was the estimated glomerular filtration rate (eGFR) at year 1. Secondary endpoints were time to moderate (eGFR <60 ml/min/1.73 m 2 ) and severe renal dysfunction (eGFR <30 ml/min/1.73 m 2 ). Risk factor analyses relied on multivariable regression models. Kidney function was mildly impaired before transplant (median eGFR=61.0 ml/min/1.73 m 2 ), improved at discharge (eGFR=72.3 ml/min/1.73 m 2 ; P < 0.001), decreased considerably in the first year (eGFR = 54.7 ml/min/1.73 m 2 ; P < 0.001), and deteriorated less rapidly thereafter. At year 1, 2004-2008 recipients exhibited a higher eGFR compared with all other patients (P < 0.001). Factors independently associated with eGFR at year 1 and with moderate and severe renal dysfunction included age, gender, pretransplant eGFR, blood pressure, glycemia, and use of prednisone (P < 0.05). In summary, kidney function worsens constantly up to two decades after cardiac transplantation, with the greatest decline occurring in the first year. Corticosteroid minimization and treatment of modifiable risk factors (hypertension, diabetes) may minimize renal deterioration.

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“…Because a high proportion of CHD patients had a previous cardiac operation, and reoperation is independently associated with high posttransplantation mortality, 11 we separately analyzed posttransplantation outcomes for patients with (reoperation group; nϭ10 484; 40.2%) and without (nonreoperation group; nϭ15 571; 59.8%) a previous sternotomy. Four groups were compared: CHD/ nonreoperation (nϭ193; 1.2%) versus non-CHD/nonreoperation (nϭ15 378; 98.8%) and CHD/reoperation (nϭ365; 1.8%) versus non-CHD/reoperation (nϭ10 119; 98.2%).…”

Section: Study Populationmentioning

confidence: 99%

Listing and Transplanting Adults With Congenital Heart Disease

et al. 2011

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Background-An increasing number of patients with congenital heart disease (CHD) are reaching adulthood and may require heart transplantation. The survival of these patients after listing and transplantation has not been evaluated. Methods and Results-A total of 41 849 patients (aged Ͼ18 years) were listed for primary transplantation during [1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005][2006][2007][2008][2009]. Patients with a history of CHD (nϭ1035; 2.5%) were compared with those with other causes (non-CHD group) (nϭ40 814; 97.5%); 26 055 (62.3%) reached transplantation and were subdivided into those with (reoperation group; nϭ10 484; 40.2%) and without (nonreoperation group; nϭ15 571; 59.8%) a previous sternotomy. Survival on the waiting list was similar between groups, but mechanical ventricular assistance was not associated with superior survival to transplantation among CHD patients. CHD patients were more likely to have body mass index Ͻ18.5 at transplantation (PϽ0.0001), were younger, and had fewer comorbidities. Early mortality among patients with CHD was high (reoperation, 18.9% versus 9.6%; PϽ0.0001; nonreoperation, 16.6% versus 6.3%; PϽ0.0001), but by 10 years, overall survival was equivalent (53.8% versus 53.6%). Analysis was limited by the lack of specific information regarding the CHD diagnosis in most patients. Conclusions-Adults with CHD have high 30-day mortality but better late survival after heart transplantation. Mechanical circulatory assistance does not improve waiting list survival in these patients. This may be due to a combination of highly complex reoperative surgery and often poor preoperative systemic health. (Circulation. 2011;123:759-767.)

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Multivariate Predictors of Heart Transplantation Outcomes in the Era of Chronic Mechanical Circulatory Support

Cited by 25 publications

References 18 publications

Pre-operative prediction of post–VAD implant mortality using easily accessible clinical parameters

Pre-operative prediction of post–VAD implant mortality using easily accessible clinical parameters

Long-term evolution, secular trends, and risk factors of renal dysfunction following cardiac transplantation

Listing and Transplanting Adults With Congenital Heart Disease

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