Division of Cardiology, Department of Medicine, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
Clin Transplant. 2023 May;37(5):e14974. doi: 10.1111/ctr.14974. Epub 2023 Mar 20.
Heart transplantation (HT) is the gold standard therapy for advanced heart failure, providing excellent long-term outcomes. However, postoperative outcomes are limited by bleeding, infections, and primary graft dysfunction (PGD) that contribute to early mortality after HT. HT candidates with pre-existing hematologic disorders, bleeding, and clotting, may represent a higher risk population. We assessed the short- and long-term outcomes of patients with pre-existing hematologic disorders undergoing HT.
Medical records of all adult patients who received HT from January 2010 to December 2019 at our institution were retrospectively reviewed. Hematologic disorders were identified via chart review and adjudicated by a board-certified hematologist. Inverse probability weighting and multivariable models were used to adjust for potential pretransplant confounders. Four hundred and ninety HT recipients were included, of whom 29 (5.9%) had a hematologic disorder. Hematologic disorders were associated with severe PGD requiring mechanical circulatory support (aOR 3.15 [1.01-9.86]; p = .049), postoperative infections (aOR 2.93 [1.38-6.23]; p = .01), and 3-year acute cellular rejection (ACR) (≥1R/1B) (aSHR 2.06 [1.09-3.87]; p = .03). There was no difference in in-hospital mortality (aOR 1.23 [.20-7.58], p = .82) or 3-year mortality (aHR 1.58 [.49-5.12], p = .44).
Patients with hematologic disorders undergoing HT are at increased risk of severe PGD, postoperative infections, and ACR, while in-hospital and 3-year mortality remain unaffected.
心脏移植（HT）是治疗晚期心力衰竭的金标准疗法，可提供优异的长期疗效。然而，术后结果受到出血、感染和原发性移植物功能障碍（PGD）的限制，这些因素导致 HT 后的早期死亡率升高。存在预先存在的血液系统疾病、出血和凝血问题的 HT 候选者可能代表着更高风险的人群。我们评估了患有预先存在的血液系统疾病并接受 HT 的患者的短期和长期结果。
回顾性分析了 2010 年 1 月至 2019 年 12 月期间在我院接受 HT 的所有成年患者的病历。通过病历审查确定血液系统疾病，并由经过认证的血液科医师进行裁决。采用逆概率加权和多变量模型来调整潜在的移植前混杂因素。共纳入 49 例 HT 受者，其中 29 例（5.9%）存在血液系统疾病。血液系统疾病与需要机械循环支持的严重 PGD 相关（优势比 3.15[1.01-9.86]；p=0.049）、术后感染（优势比 2.93[1.38-6.23]；p=0.01）和 3 年急性细胞排斥（≥1R/1B）（调整后危险比 2.06[1.09-3.87]；p=0.03）。院内死亡率无差异（优势比 1.23[0.20-7.58]；p=0.82）或 3 年死亡率（调整后风险比 1.58[0.49-5.12]；p=0.44）。
患有血液系统疾病并接受 HT 的患者发生严重 PGD、术后感染和急性细胞排斥的风险增加，而院内和 3 年死亡率保持不变。
