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

详细信息    查看全文

• 作者：P. Lebray¹ ; S. Varnous² ; P. Leprince² ; C.E. Luyt³ ; G. Rousseau⁴ ; A. Pascale⁵ ; D. Thabut¹ ; V. Ratziu¹ ; J.C. Vaillant⁴ ; J. Chastre³ ; A. Pavie²
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2013
• 出版时间：April, 2013
• 年：2013
• 卷：32
• 期：4_supp_S
• 页码：S52
• 全文大小：101 K

文摘

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¡Àyears-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 ¦Ìmol/l, p =0,001), creatininemia (129,5 vs.101,5 ¦Ìmol/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¡Ý16 and ascitis are independant factors associated with early post-transplant mortality.