Complications in the postoperative period of heart transplantation: a retrospective cohort

Abstract

Abstract Introduction Primary graft dysfunction, graft rejection, renal dysfunction, and infections are frequent complications after heart transplantation (HT), and there is evidence that previous comorbidities and risk factors, such as arterial hypertension, diabetes, dyslipidemia, and smoking can predispose or even aggravate the development and evolution of these disorders. Objectives This study verified the association between previous comorbidities and risk factors in the development of complications after HT. Methods A retrospective cohort study was conducted and included 91 HT patients and followed up to 10 years postoperatively, in a Brazilian hospital between 1988 and 2020. The study was designed according to the recommendations of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Data were collected by retrospective analysis of medical records. The independent variables were the following: Demographic and clinical conditions of the subjects during the preoperative period, such as age, sex, arterial hypertension, diabetes, dyslipidemia, and smoking. The outcome variables were: Acute cellular rejection, infection, renal dysfunction, hemodialysis therapy after the HT, and death. Data were submitted to descriptive, Fisher’s Exact Test and Chi-square analyses, with p < 0.05 as the level of statistical significance. The local Ethics Committee approved the study (CAAE: 53026321.4.0000.5404). Results There was a predominance of women (67.0%), with a mean age of 49.4 (11.1) years. Most of them were diagnosed with hypertension (49.45%), smokers (38.46%), dyslipidemia (18.68%), and diabetes (16.48%). Regarding complications, 73.63% of the sample of this study developed acute cellular rejection, 61.54% had infections, 25.47% developed renal dysfunction, in addition to 24.18% of patients received hemodialysis treatment after HT. More than half of patients died (58.24%). Positive associations of strong magnitude were found between renal dysfunction and hypertension (p=0.0018); of moderate magnitude between acute cellular rejection and smoking (p=0.0386) and between infection and smoking (p=0.0156). Furthermore, it was observed that those who developed renal dysfunction had a high association with hemodialysis (p<0.0001). Conclusion This study demonstrated that hypertension may be associated with the development of renal dysfunction, and smoking may contribute to acute cellular rejection and infection after HT. These findings provide support to health professionals to implement prevention strategies and early detection of complications in the postoperative period.