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Intraoperative hemoglobin level and primary graft dysfunction in adult heart transplantation

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Abstract

Objectives

We investigated the association between recipient serum hemoglobin and primary graft dysfunction after heart transplantation.

Methods

We retrospectively evaluated adult patients who underwent heart transplantation at our institution from 2007 to 2016. Patients were grouped into three quantiles based on serum hemoglobin level at the time of donor heart reperfusion. Primary graft dysfunction was analyzed in each quantile.

Results

We assessed 69 patients, and 12 showed primary graft dysfunction. The mean hemoglobin levels at reperfusion in the low, middle, and high hemoglobin quantiles were 7.6 ± 0.9, 9.2 ± 0.3, and 10.4 ± 0.6 mg/dL, respectively. There were no significant between-group differences in pre-heart transplantation serum hemoglobin levels (p = 0.53). The odds ratio for primary graft dysfunction was significantly higher in the low hemoglobin quantile (5.80; 95% confidence interval, 2.32–14.5; p < 0.001) than in the middle (1.14; 95% confidence interval, 0.40–3.23) and high (reference) hemoglobin quantiles. The odds ratios for primary graft dysfunction in the three quantiles based on pre-heart transplantation hemoglobin levels did not differ significantly.

Conclusions

Low recipient serum hemoglobin levels at the time of donor heart reperfusion was independently associated with primary graft dysfunction after heart transplantation. Intraoperative management of recipient hemoglobin using red blood cell transfusion may prevent post-heart transplantation primary graft dysfunction.

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References

  1. Stehlik J, Edwards LB, Kucheryavaya AY, Aurora P, Christie JD, Kirk R, et al. The registry of the international society for heart and lung transplantation: twenty-seventh official adult heart transplant report 2010. J Heart Lung Transplant. 2010;10:1089–103.

    Article  Google Scholar 

  2. Kobashigawa J, Zuckermann A, Macdonald P, Leprince P, Esmailian F, Luu M, et al. Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant. 2014;33:327–40.

    Article  Google Scholar 

  3. Russo MJ, Iribarne A, Hong KN, Ramlawi B, Chen JM, Takayama H, et al. Factors associated with primary graft failure after heart transplantation. Transplantation. 2010;90:444–50.

    Article  Google Scholar 

  4. Segovia J, Cosío MD, Barceló JM, Bueno MG, Pavía PG, Burgos R, et al. RADIAL: a novel primary graft failure risk score in heart transplantation. J Heart Lung Transplant. 2011;30:644–51.

    Article  Google Scholar 

  5. Young JB, Hauptman PJ, Naftel DC, Ewald G, Aaronson K, Dec GW, et al. Determinants of early graft failure following cardiac transplantation, a 10-year, multi-institutional, multivariable analysis. J Heart Lung Transplant. 2001;20:212.

    Article  Google Scholar 

  6. Hong KN, Iribarne A, Worku B, Takayama H, Gelijns AC, Naka Y, et al. Who is the high-risk recipient? Predicting mortality after heart transplant using pretransplant donor and recipient risk factors. Ann Thorac Surg. 2011;92:520–7.

    Article  Google Scholar 

  7. Iyer A, Kumarasinghe G, Hicks M, Watson A, Gao L, Doyle A, et al. Primary graft failure after heart transplantation. J Transplant. 2011;2011:175768.

    Article  Google Scholar 

  8. Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? J Thorac Cardiovasc Surg. 2003;125:1438–50.

    Article  Google Scholar 

  9. Karkouti K, Beattie WS, Wijeysundera DN, Rao V, Chan C, Dattilo KM, et al. Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg. 2005;129:391–400.

    Article  CAS  Google Scholar 

  10. Karkouti K, Djaiani G, Borger MA, Rao V, Chan C, Dattilo KM, et al. Low hematocrit during cardiopulmonary bypass is associated with increased risk of perioperative stroke in cardiac surgery. Ann Thorac Surg. 2005;80:1381–7.

    Article  Google Scholar 

  11. Tabachnick BG, Fidell LS. Using multivariate statistics. Boston: Pearson/Allyn; 2006.

    Google Scholar 

  12. Ranucci M, Romitti F, Isgrò G, Cotza M, Brozzi S, Boncilli A, et al. Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations. Ann Thorac Surg. 2005;80:2213–20.

    Article  Google Scholar 

  13. de Somer F, Mulholland JW, Bryan MR, Aloisio T, Van Nooten GJ, Ranucci M. O2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management? Crit Care. 2011;15:R192.

    Article  Google Scholar 

  14. Bennett MJ, Rajakaruna C, Bazerbashi S, Webb G, Gomez-Cano M, Lloyd C. Oxygen delivery during cardiopulmonary bypass (and renal outcome) using two systems of extracorporeal circulation: a retrospective review. Interact Cardiovasc Thorac Surg. 2013;16:760–4.

    Article  Google Scholar 

  15. Koning NJ, Vonk AB, Meesters MI, Oomens T, Verkaik M, Jansen EK, et al. Microcirculatory perfusion is preserved during off-pump but not on-pump cardiac surgery. J Cardiothorac Vasc Anest. 2014;28:336–41.

    Article  Google Scholar 

  16. Koning NJ, Vonk AB, van Barneveld LJ, Beishuizen A, Atasever B, van den Brom CE, et al. Pulsatile flow during cardiopulmonary bypass preserves postoperative microcirculatory perfusion irrespective of systemic hemodynamics. J Appl Physiol. 2012;112:1727–34.

    Article  Google Scholar 

  17. Walley KR. Heterogeneity of oxygen delivery impairs oxygen extraction by peripheral tissues: theory. J Appl Physiol. 1996;81:885–94.

    Article  CAS  Google Scholar 

  18. Goldman D, Bateman RM, Ellis CG. Effect of decreased O2 supply on skeletal muscle oxygenation and O2 consumption during sepsis: role of heterogeneous capillary spacing and blood flow. Am J Physiol Heart Circ Physiol. 2006;290:2277–85.

    Article  Google Scholar 

  19. De Blasi RA, Tonelli E, Arcioni R, Mercieri M, Cigognetti L, Romano R, et al. In vivo effects on human skeletal muscle oxygen delivery and metabolism of cardiopulmonary bypass and perioperative hemodilution. Intensive Care Med. 2012;38:413–21.

    Article  CAS  Google Scholar 

  20. Cabrales P, Tsai AG, Intaglietta M. Microvascular pressure and functional capillary density in extreme hemodilution with low- and high-viscosity dextran and a low-viscosity Hb-based O2 carrier. Am J Physiol Heart Circ Physiol. 2004;287:H363–H373373.

    Article  CAS  Google Scholar 

  21. See SB, Clerkin KJ, Kennel PJ, Zhang F, Weber MP, Rogers KJ, et al. Ventricular assist device elicits serum natural IgG that correlates with the development of primary graft dysfunction following heart transplantation. J Heart Lung Transplant. 2017;36:862–70.

    Article  Google Scholar 

  22. Ranucci M, Conti D, Castelvecchio S, Menicanti L, Frigiola A, Ballotta A, et al. Hematocrit on cardiopulmonary bypass and outcome after coronary surgery in nontransfused patients. Ann Thorac Surg. 2010;89:11–7.

    Article  Google Scholar 

  23. Yuruk K, Almac E, Bezemer R, Goedhart P, de Mol B, Ince C. Blood transfusions recruit the microcirculation during cardiac surgery. Transfusion. 2011;51:961–7.

    Article  Google Scholar 

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Acknowledgements

This study was supported by the Clinical Investigator’s Research Project in Osaka University Graduate School of Medicine.

Funding

The authors received no funding for this study.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita City, Osaka, 565-0871, Japan

    Yuki Nakamura, Shunsuke Saito, Shigeru Miyagawa, Yasushi Yoshikawa, Hiroki Hata, Daisuke Yoshioka, Koichi Toda & Yoshiki Sawa

  2. Department of Social Medicine, Public Health, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita City, Osaka, 565-0871, Japan

    Ryoto Sakaniwa

Authors
  1. Yuki Nakamura
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  2. Shunsuke Saito
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  3. Shigeru Miyagawa
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  4. Yasushi Yoshikawa
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  5. Hiroki Hata
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  6. Daisuke Yoshioka
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  7. Ryoto Sakaniwa
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  8. Koichi Toda
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  9. Yoshiki Sawa
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Corresponding author

Correspondence to Yoshiki Sawa.

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Conflict of interest

None declared.

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All patients provided written informed consent.

Ethical approval

This study was approved by the Ethics Committee of Osaka University Hospital and conducted in accordance with the Declaration of Helsinki.

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Nakamura, Y., Saito, S., Miyagawa, S. et al. Intraoperative hemoglobin level and primary graft dysfunction in adult heart transplantation. Gen Thorac Cardiovasc Surg 68, 1260–1269 (2020). https://doi.org/10.1007/s11748-020-01360-z

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  • DOI: https://doi.org/10.1007/s11748-020-01360-z

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