IMPACT OF IMMEDIATE POST-OPERATIVE STROKE ON SURVIVAL OF PATIENTS AFTER HEART TRANSPLANTATION

Abstract

BACKGROUND Immediate post-operative stroke is much more common after heart transplantation as compared to other types of cardiac procedures. It has a devastating effect on the quality of life, and it remains unclear how it affects the short and long-term survival of transplant recipients. The objective of this study is to identify the clinical predictors of immediate post-transplant stroke and its impact on short and long-term survival. METHODS AND RESULTS The Scientific Registry of Transplant Recipients (SRTR) was queried to include 65097 adult patients (age ≥18 years) who underwent orthotopic heart transplantation between 1987 and 2018. The incidence of immediate post-transplant stroke was 2%. In the first arm of the analysis, we identified clinical predictors of immediate post-transplant stroke. In the second arm of the analysis, we compared the short and long-term survival of patients with vs. without immediate post-transplant stroke. Analyses were performed using multivariable logistic regression (for the first arm) and piece-wise multivariable Cox regression (for the second arm). Female gender (Odds Ratio (OR) 1.19, 95% CI 1.05-1.34), peripheral vascular disease (OR 1.54, 95% CI 1.16-2.06), history of cerebrovascular disease (OR 1.52, 95% CI 1.23-1.88), prior cardiac surgery (OR 1.63, 95% CI 1.42-1.88), and increased age (OR 1.10, 95% CI 1.05-1.15) were all predictors of immediate post-transplant stroke. Immediate post-transplant stroke increased the hazard for both short and long-term mortality (Hazard Ratio for mortality: 4.7 (p < 0.0001) at 30 days; 3.9 (p < 0.0001) at 30-365 days; 1.3 (p < 0.0001) after 365 days). CONCLUSION Immediate post-transplant stroke has a devastating impact on both short and long-term survival. Certain patient populations (such as females) are at an increased risk of developing immediate post-transplant stroke, and future research should aim at optimizing the brain protection strategies in those at risk. Immediate post-operative stroke is much more common after heart transplantation as compared to other types of cardiac procedures. It has a devastating effect on the quality of life, and it remains unclear how it affects the short and long-term survival of transplant recipients. The objective of this study is to identify the clinical predictors of immediate post-transplant stroke and its impact on short and long-term survival. The Scientific Registry of Transplant Recipients (SRTR) was queried to include 65097 adult patients (age ≥18 years) who underwent orthotopic heart transplantation between 1987 and 2018. The incidence of immediate post-transplant stroke was 2%. In the first arm of the analysis, we identified clinical predictors of immediate post-transplant stroke. In the second arm of the analysis, we compared the short and long-term survival of patients with vs. without immediate post-transplant stroke. Analyses were performed using multivariable logistic regression (for the first arm) and piece-wise multivariable Cox regression (for the second arm). Female gender (Odds Ratio (OR) 1.19, 95% CI 1.05-1.34), peripheral vascular disease (OR 1.54, 95% CI 1.16-2.06), history of cerebrovascular disease (OR 1.52, 95% CI 1.23-1.88), prior cardiac surgery (OR 1.63, 95% CI 1.42-1.88), and increased age (OR 1.10, 95% CI 1.05-1.15) were all predictors of immediate post-transplant stroke. Immediate post-transplant stroke increased the hazard for both short and long-term mortality (Hazard Ratio for mortality: 4.7 (p < 0.0001) at 30 days; 3.9 (p < 0.0001) at 30-365 days; 1.3 (p < 0.0001) after 365 days). Immediate post-transplant stroke has a devastating impact on both short and long-term survival. Certain patient populations (such as females) are at an increased risk of developing immediate post-transplant stroke, and future research should aim at optimizing the brain protection strategies in those at risk.