Nixon Jennifer L, Kfoury Abdallah G, McCubrey Raymond, Brunisholz Kim, Bair Tami, Balling Kyle D, Budge Deborah, Doty John, Rasmusson Brad, Reid Bruce, Smith Hildegard, Thomsen George, Goddard Mark, Alharethi Rami
1 Heart Failure and Transplant Program, Intermountain Heart Institute, Salt Lake City, UT.
Transplantation. 2015 Jun;99(6):1216-9. doi: 10.1097/TP.0000000000000508.
Lactic acidosis (LA) frequently occurs after heart transplantation (HTx). It is hypothesized to be related to inotropic support or metabolic derangements from chronic heart failure. As such, restoring hemodynamic stability with mechanical circulatory support before HTx should mitigate this problem. Our aim was to evaluate the incidence and outcomes of LA after HTx.
We evaluated HTx recipients January 2000 to May 2011. Post-HTx outcomes included graft dysfunction, length of intensive care unit stay, length of hospital stay, inotropic support, and survival.
Of 143 eligible patients, 98.6% had LA, 67% severe, after HTx. Data were analyzed based on the severity of LA. Time to peak lactate, intensive care unit stay, length of hospital stay, peak glucose, inotropic dose, graft dysfunction, and survival after HTx were similar between groups. Statistically significant differences included pretransplant support (25.6% mechanical circulatory support in nonsevere vs. 44.9% severe LA), hospitalization at the time of HTx (37.2% vs. 21.4%), glucose at the time of peak lactate (182.88 ± 69.80 vs. 221.31 ± 56.91), ischemic time (187.4 ± 63.1 vs. 215.5 ± 68.1), and duration of inotrope.
Severe LA is common after HTx, though it appears to be transient and benign. Mechanical circulatory support after HTx does not prevent LA. High lactate levels are associated with longer ischemic times, longer duration of inotrope, and correspond with higher glucose levels. The underlying mechanism is yet to be satisfactorily elucidated.
乳酸酸中毒（LA）在心脏移植（HTx）后经常发生。据推测，它与正性肌力支持或慢性心力衰竭引起的代谢紊乱有关。因此，在HTx前使用机械循环支持恢复血流动力学稳定性应可缓解此问题。我们的目的是评估HTx后LA的发生率和结局。
我们评估了2000年1月至2011年5月期间的HTx受者。HTx后的结局包括移植物功能障碍、重症监护病房住院时间、住院时间、正性肌力支持和生存率。
在143例符合条件的患者中，98.6%在HTx后发生LA，其中67%为重度。根据LA的严重程度对数据进行分析。两组之间的乳酸峰值时间、重症监护病房住院时间、住院时间、血糖峰值、正性肌力药物剂量、移植物功能障碍和HTx后的生存率相似。统计学上的显著差异包括移植前支持（非重度LA中25.6%使用机械循环支持，重度LA中为44.9%）、HTx时的住院情况（37.2% vs. 21.4%）、乳酸峰值时的血糖（182.88±69.80 vs. 221.31±56.91）、缺血时间（187.4±63.1 vs. 215.5±68.1）和正性肌力药物使用持续时间。
重度LA在HTx后很常见，尽管它似乎是短暂且良性的。HTx后使用机械循环支持并不能预防LA。高乳酸水平与更长的缺血时间、更长的正性肌力药物使用持续时间相关，并且与更高的血糖水平相对应。其潜在机制尚未得到令人满意的阐明。
