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. 2023 May;37(5):e14974.
doi: 10.1111/ctr.14974. Epub 2023 Mar 20.

The impact of pre-existing hematologic disorders on morbidity and mortality following heart transplantation: Focus on early graft dysfunction

Matthew R Carey  1 , Annamaria Ladanyi  1 , Yonatan Mehlman  1 , Rebecca L Molinsky  2 , Andrew Eisenberger  3 , Kevin J Clerkin  1 , Justin G Aaron  4 , Koji Takeda  5 , Gabriel T Sayer  1 , Nir Uriel  1 , Ryan T Demmer  2 , Paolo C Colombo  1 , Melana Yuzefpolskaya  1
Affiliations

The impact of pre-existing hematologic disorders on morbidity and mortality following heart transplantation: Focus on early graft dysfunction

Matthew R Carey et al. Clin Transplant. 2023 May.

Abstract

Background: 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.

Methods and results: 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).

Conclusions: 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.

Keywords: coagulopathy; heart transplantation; hematologic disorders; primary graft dysfunction.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

Ms. Molinsky is supported by an NHLBI training grant (T32HL007779). Dr. Clerkin is supported in part by an NIH grant (K23HL148528). Dr. Sayer reports consulting fees from Abbott and serving on the advisory board of CareDx. Dr. Uriel reports serving on the medical advisory board of LiveMetric, Leviticus Cardio, and Revamp Medical as well as institutional grant support from Abbott, Abiomed, and FIRE1 and meeting support from Abbott. Dr. Colombo reports personal fees from Roche and Abbott. All other authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Cumulative incidence functions for long-term outcomes for those with hematologic disorders (n = 29) and those without such conditions (n = 461), including (A) mortality, (B) acute cellular rejection (ISHLT grade 1R/1B or greater), (C) cardiac allograft vasculopathy, and (D) development of donor-specific antibodies.
See this image and copyright information in PMC

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