Recipient Anemia during Cardiopulmonary Bypass is the Risk Factor of Primary Graft Failure in Heart Transplantation

Abstract

Purpose: Primary graft failure (PGF) is a devastating complication of heart transplantation (HTx). Although the systemic inflammatory response in recipient is one of the scenario of PGF, its mechanism is poorly understood. The aim of this study is to elucidate a recipient risk factor of PGF associated with systemic inflammation. Method: Fifty-seven consecutive patients undergoing adult HTx between 2007 and 2016 at our hospital were reviewed retrospectively. Perioperative Interleukin (IL)-6 was measured. We defined PGF according to the severity scale of PGF defined at The International Society of Heart Lung Transplantation consensus meeting in 2014. Cytokine levels and perioperative recipient factors were compared between patients with PGF and without PGF. ResultOf 58 patients, 14 (24.1%) developed moderate to severe PGF. Patients with PGF had significantly higher levels of IL-6 (1262 ± 3422 pg/ml vs. 177 ± 260 pg/ml; P = .04) especially before the reperfusion of transplanted hearts. In patients with PGF, Hemoglobin (Hb) level at the time of reperfusion was significantly lower than that in patients without PGF (7.8 ± 1.2 mg/dl vs. 9.3 ± 1.1 mg/dl; P < .0001). Only Hb level had significant correlation with IL-6 level before reperfusion (r = -0.618, P = .0206). ConclusionRecipient anemia during the cardiopulmonary bypass, which might cause systemic inflammation, is one of RRFs of PGF.