The Incidence, Risk Factors, and Outcomes of Hyperlactatemia after Heart Transplantation

Abstract

SummaryHyperlactatemia (HL) is associated with tissue hypoperfusion during cardiac surgery, which results in postoperative morbidity and mortality among patients undergoing cardiopulmonary bypass surgery. The aim of this study was to determine the incidence, risk factors, and outcome of HL after heart transplantation (HTx) in one of the largest Japanese single-center cohorts. We retrospectively studied the lactate levels in 49 patients who underwent HTx at the University of Tokyo Hospital from August 1, 2010 to November 30, 2015. All of the patients were over 20 years of age. Arterial blood samples were analyzed during the operation and until 24 hours after surgery. Twenty-nine patients (59.2%) had HL after intensive-care unit admission. At 24 hours after surgery, the lactate levels of all patients had recovered to the normal range. A multivariate analysis showed that the total ischemic time of the donor heart (odds ratio [OR], 1.0176; 95% confidence interval [CI], 1.0004-1.0375; P = 0.0444) and the duration of preoperative left ventricular assist device (LVAD) support (OR, 0.9977; 95% CI, 0.9952-0.9997; P = 0.0218) were risk factors for HL. Pulmonary complications were noted in 24.1% of the patients with high lactate values but in none of the patients without HL (P = 0.0182); however, there were no cases of hospital death, and the length of hospital stay did not differ to a statistically significant degree between HL groups (P = 0.719). Although HL after HTx was common, it appeared to be transient and benign. Donor heart ischemia and the duration of preoperative LVAD support were associated with HL after transplantation.(Int Heart J 2018; 59: 81-86)

Postoperative hyperlactatemia and serum lactate level trends among heart transplant recipients

“…In the presented research, hyperlactatemia was considered with the of >1.6 mmol/l, same as it is for other cardiac surgeries and non-surgical patients in our center. Despite the initially emerging pattern with early peak of the lactate values, that was similar to other post-HTX lactate analyses (Hsu et al, 2015;Hoshino, Kinoshita & Ono, 2018), more detailed evaluation revealed various serum lactate level trends. The interpretation of the initial results indicates the increase to the highest serum lactate level within first 6 postoperative hours with subsequent gradual decrease (Fig.…”

“…Under anaerobic conditions, cellular metabolism converts pyruvate to lactate. Therefore, serum lactate levels relate to the oxygen debt and correspond with the severity of tissue hypoperfusion (Adeva-Andany et al, 2014;Hoshino, Kinoshita & Ono, 2018). The normal plasma lactate concentration for ABG is reported from 0.3 to 1.6 mmol/L (Broder & Weil, 1964), whereas lactic acidosis is generally defined with a threshold of greater than four mmol/L, even in the absence of overt acidemia.…”

“…Based on this estimation, elevated serum lactate levels were observed among 59.2% of post-HTX patients, with higher occurrence of postoperative pulmonary complications within this subgroup. As no in-hospital deaths were reported, no testing was performed to determine the impact on early mortality (Hoshino, Kinoshita & Ono, 2018). Nevertheless, the detailed exploration of the cut-off value, appointed by the upper limit of normal for serum lactate concentration, has never been presented in post-HTX patients before.…”

Risk factors for persistent elevation of perioperative lactate levels in gastric cancer surgery

“…Lactate studies in surgical patients usually appear in cardiac procedures. In the analysis of the risk factors for lactate elevation in this patient group of Hoshino et al, 11 operative time was not significant (p = 0.439. In contrast, in the study of Wu et al 12 the operative time was closely related to severe hyperlactatemia (p = 0.016).…”

Institutional Case-Volume and Mortality After Heart Transplantation

“…16) According to data from a Japanese center with an annual volume of over 10 transplants, there was no in-hospital mortality after HT. 17) However, there are no requirements/regulations with regards to institutional performance in organ transplantation in Korea. Given the recent increase in HTs performed in Korea, 18) the association between HT case-volume and posttransplant mortality was analyzed using data from the National Health Insurance Service (NHIS) of Korea to see if the same relationship holds and if minimal performance requirements would be beneficial.…”