Risk Factors of Heart Transplantation in Recipients with Pretransplant Peripheral Veno-arterial Extracorporeal Membrane Oxygenation (pVAECMO)

Vitaly Poptsov, Ekatherina Spirina, Nadezda Koloskova, Sergey Uhrenkov, Anastasiya Dogonasheva, Elnur Aliev, Valeriy Hatutsky

Federal State Budgetary Institution “Academician V.I.Shumakov Federal Research Center of Transplantology and Artificial Organs”, Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow, Russia

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – A

Abstract

Introduction. pVAECMO is one of short-term mechanical circulation support (MCS) methods in heart transplant candidates needed in urgent heart transplantation (HT).

The aim of the study was to establish perioperative risk factors for hospital lethal outcome in heart recipients with pretransplant pVAECMO.

Materials and methods. In 2011-2016 yrs 135 recipients (114 males (84.4%), 21 females (15.6%), ages 12-72 (43 ± 14) yrs) were supported before HT by pVAECMO (6.6 ± 6 days). Patients were divided into two groups. The first group included 117 (85.9%) recipients discharged after HT, in the 2nd group - 19 (14.1%) recipients who died in the hospital period. The statistical significance of 32 selected peri-transplant risk factors for lethal outcome was determined.

Results of the study. In 2nd group values of total bilirubin, ALT, AST, creatinine and urea were higher before and after the HT (p<0.05). The heart donor risk factors were statistically significant: donor age > 50 years (OR = 3.049, confidence interval (CI) 1.16-8.013, p = 0.0285); norepinephrine > 600 ng/kg/min (OR = 3.818, CI = 1.169-12.475, p = 0.0295). Recipient’s risk factors: urea > 10 mmol/l (OR = 7, CI = 1.569-31.871, p = 0.0124); pVAECMO after HT > 2 days (OR = 21.4, CI = 2.392-191.46, p = 0.0019); inotropic index> 20 (OR = 4.922, CI = 1.317-18.393, p = 0.0234); blood loss > 2.5 l (OR = 8.556, CI = 2.391-30.619, p = 0.0234); blood transfusion > 6 units (OR = 2.833, CI = 1.119-7.173, p = 0.0378); fresh frozen plasma > 10 units (OR = 2.964, CI = 1.16-7.573, p = 0.0244).

Conclusion. Outcomes of heart recipients with pretransplant pVAECMO is determined by the severity of multiorgan disorders, use of high-risk cardiac donors, the severity of early cardiac allograft dysfunction and blood loss.