Extracorporeal Cytokine Hemoadsorption During Orthotopic Heart Transplantation: A Comparative Study

Abstract

<h3>Purpose</h3> Increasingly used hemoadsorption filters (Cytosorb®, CytoSorbents Europe GmbH) promote the attenuation of uncontrolled immune responses in patients with elevated levels of pro-inflammatory cytokines (e.g. septic shock or hyperinflammation in cardiac surgery). In patients undergoing orthotopic heart transplantation (OHT) chronic organ hypoperfusion, cardiopulmonary bypass and first contact to the allograft may add up to the development of a pro-inflammatory environment. This single center study evaluates the effect of Cytosorb therapy (CS) on vasopressor demand, postoperative complications and general outcome in patients undergoing OHT. <h3>Methods</h3> From 01/10-08/21 156 Patients underwent OHT. Separated into three groups to eliminate changes in clinical management over time, we compared laboratory values, vasopressor demands, mean arterial pressure (MAP), lactate levels, postoperative complications and general outcome between 81 patients before the induction of CS (01/10-02/17), 51 patients treated with CS (04/17-09/20) and 22 after CS (11/19-08/21). <h3>Results</h3> The groups showed no differences in terms of age, sex, BMI, preoperative laboratory values or total ischemic time of the allograft (after CS 236 ± 40min, CS 230 ± 50min, before CS 242 ± 52min, p=0.69). There was no difference in postoperative vasopressor demand, MAP or postoperative lactate levels between CS group and after CS group. 30-day-survival was equal in all groups (after CS 95.5%, CS 94.4%, before CS 86.7%, p=0.88). 1-year-survival was better in CS group compared to patients before CS (CS 94,1%, before CS 75,9%, p=0.007). There were no significant differences in primary graft failures (after CS 0%, CS 9,8%, before CS 8,4%, p=0.33). However, a significant increase in gastrointestinal ischemia and subsequent bowel surgery in CS group was observed (after CS 0%, CS 15.6%, before CS 9.6%, p=0.035). <h3>Conclusion</h3> Our study showed no perioperative advantage of CS in OHT regarding vasopressor demands, MAP, postoperative lactate levels and 30-day survival. However, an increase in gastrointestinal ischemic events in patients treated with CS evokes questions about how immune-modulation plays a role in the development of gastrointestinal complications. Further investigation will be necessary to evaluate risks and benefits of cytokine adsorption therapy in patients undergoing OHT.