Neurologic Complications in Heart Transplant Recipients Readmitted to the Intensive Care Unit

ObjectiveThe objective of this study was to define the characteristics of hospital care use during the year prior to heart transplantation.MethodsA retrospective cohort of heart transplant recipients registered on the national hospital discharge database between 2010 and 2015 was analysed.ResultsIn this cohort of 2379 heart transplant recipients (mean age: 48 years, 74% men), 91% had been admitted at least once, for at least 1 day, to a short-stay hospital during the year before transplantation (mean: 4.3 days), and 84% had at least one cardiovascular diagnosis (heart failure and cardiogenic shock: 60%). At least one intensive care stay was reported for 61% of patients, a rehabilitation stay was reported for 30%, mechanical circulatory support was reported for 12%, and ventilatory support was reported for 15%. The median interval between admission and transplantation was 5 days (interquartile QI–Q3, 0–16). The hospital mortality was higher for patients not hospitalised before transplantation (18% vs 15%). Their transplantation hospitalisation diagnosis, compared with patients hospitalised before transplantation, was more frequently cardiomyopathy (31% vs 27%) or heart failure (28% vs 18%), and less frequently myocardial infarction (1% vs 12%).ConclusionThis study demonstrates a high hospitalisation rate before heart transplantation and identifies three groups of patients: 1—patients with a high hospitalisation rate and terminal heart failure requiring circulatory support who experienced at least one intensive care unit stay; 2—patients with a history of hospitalisation, mainly for heart disease, without circulatory support requirement; and 3—patients with no pretransplantation overnight stay. These findings provide useful information to evaluate the medical benefits and needs for transplantation, and identify areas for improvement in heart transplantation listing criteria.

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Intraoperative and Postoperative Hemodynamic Predictors of Acute Kidney Injury in Pediatric Heart Transplant Recipients

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1736336 ◽

2021 ◽

Author(s):

Seth A. Hollander ◽

Sukyung Chung ◽

Sushma Reddy ◽

Nina Zook ◽

Jeffrey Yang ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Intensive Care ◽

Patient Outcomes ◽

Heart Transplant ◽

Multivariable Analysis ◽

Kidney Injury ◽

Transplant Recipients ◽

Heart Transplant Recipients ◽

Pediatric Heart Transplant

AbstractAcute kidney injury (AKI) is common after pediatric heart transplantation (HT) and is associated with inferior patient outcomes. Hemodynamic risk factors for pediatric heart transplant recipients who experience AKI are not well described. We performed a retrospective review of 99 pediatric heart transplant patients at Lucile Packard Children's Hospital Stanford from January 1, 2015, to December 31, 2019, in which clinical and demographic characteristics, intraoperative perfusion data, and hemodynamic measurements in the first 48 postoperative hours were analyzed as risk factors for severe AKI (Kidney Disease: Improving Global Outcomes [KDIGO] stage ≥ 2). Univariate analysis was conducted using Fisher's exact test, Chi-square test, and the Wilcoxon rank-sum test, as appropriate. Multivariable analysis was conducted using logistic regression. Thirty-five patients (35%) experienced severe AKI which was associated with lower intraoperative cardiac index (p = 0.001), higher hematocrit (p < 0.001), lower body temperature (p < 0.001), lower renal near-infrared spectroscopy (p = 0.001), lower postoperative mean arterial blood pressure (MAP: p = 0.001), and higher central venous pressure (CVP; p < 0.001). In multivariable analysis, postoperative CVP >12 mm Hg (odds ratio [OR] = 4.27; 95% confidence interval [CI]: 1.48–12.3, p = 0.007) and MAP <65 mm Hg (OR = 4.9; 95% CI: 1.07–22.5, p = 0.04) were associated with early severe AKI. Children with severe AKI experienced longer ventilator, intensive care, and posttransplant hospital days and inferior survival (p = 0.01). Lower MAP and higher CVP are associated with severe AKI in pediatric HT recipients. Patients, who experienced AKI, experienced increased intensive care unit (ICU) morbidity and inferior survival. These data may guide the development of perioperative renal protective management strategies to reduce AKI incidence and improve patient outcomes.

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