Wang Chen Chia, Petrovic Mark, Ahmad Awab, Lima Brian, Tipograf Yuliya, Trahanas John, Bommareddi Swaroop, Nguyen Duc, Siddiqi Hasan, Jelly Christina, Balakrishna Aditi, Schlendorf Kelly H, Shah Ashish S
Vanderbilt University School of Medicine, Nashville, Tenn.
Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
JTCVS Open. 2025 Mar 20;25:227-240. doi: 10.1016/j.xjon.2025.03.009. eCollection 2025 Jun.
The revised US donor heart allocation policy allows for transplantation in more critically ill patients with heart failure. This study examines the association between index hospitalization and 1-year functional outcomes in the modern era.
All adult, single-organ heart transplant recipients at a single institution from October 2018 to January 2023 were retrospectively reviewed. Multistate Cox regression identified predictors of death in hospital or prolonged length of stay. Length of stay was then associated with 1-year Karnofsky Performance score, chronic dialysis, readmission, and mortality.
A total of 441 patients were stratified into a death in hospital group (n = 28) and short (≤30 days, n = 341), medium (30-60 days, n = 59), and long (≥60 days, n = 16) length of stay groups. Short index length of stay is associated with higher 1-year performance status scores and lower rates of chronic dialysis and readmissions compared with medium and long length of stay groups, as well as superior 1-year survival compared with the long length of stay group. Congenital and graft failure etiology, pretransplant left ventricular assist device, post-transplant extracorporeal membrane oxygenation, and post-transplant dialysis were independent predictors of death in hospital. Pretransplant left ventricular assist device, hypertension, poor baseline renal function, post-transplant extracorporeal membrane oxygenation, and post-transplant dialysis were risk factors for prolonged hospitalization.
Both preoperative recipient characteristics and early outcomes are predictive of in-hospital mortality or prolonged length of stay after heart transplant. Longer length of stay is associated with inferior 1-year functional outcomes and mortality. This study suggests the need for interventions targeted toward high-risk patients to improve early and late outcomes.
修订后的美国供体心脏分配政策允许为病情更危重的心力衰竭患者进行移植。本研究探讨了在现代，首次住院与1年功能结局之间的关联。
对2018年10月至2023年1月在单一机构接受单器官心脏移植的所有成年患者进行回顾性研究。多状态Cox回归分析确定了住院死亡或住院时间延长的预测因素。然后将住院时间与1年的卡诺夫斯基功能状态评分、慢性透析、再入院率和死亡率相关联。
总共441例患者被分为住院死亡组（n = 28）以及住院时间短（≤30天，n = 341）、中（30 - 60天，n = 59）和长（≥60天，n = 16）的组。与住院时间中等和长的组相比，首次住院时间短与1年功能状态评分更高、慢性透析和再入院率更低相关，并且与住院时间长的组相比，1年生存率更高。先天性和移植物衰竭病因、移植前左心室辅助装置、移植后体外膜肺氧合以及移植后透析是住院死亡的独立预测因素。移植前左心室辅助装置、高血压、基线肾功能差、移植后体外膜肺氧合以及移植后透析是住院时间延长的危险因素。
术前受者特征和早期结局均能预测心脏移植后的住院死亡率或住院时间延长。住院时间较长与1年功能结局较差和死亡率较高相关。本研究表明需要针对高危患者进行干预以改善早期和晚期结局。
