Affiliation:
1. Division of Cardiology Department of Medicine NewYork‐Presbyterian Columbia University Irving Medical Center New York New York USA
2. Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis Minnesota USA
3. Division of Hematology/Oncology Department of Medicine NewYork‐Presbyterian/Columbia University Irving Medical Center New York New York USA
4. Division of Infectious Diseases Department of Medicine NewYork‐Presbyterian/Columbia University Irving Medical Center New York New York USA
5. Division of Cardiac Thoracic & Vascular Surgery Department of Surgery NewYork‐Presbyterian Columbia University Irving Medical Center New York New York USA
Abstract
AbstractBackgroundHeart 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 resultsMedical 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).ConclusionsPatients 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.
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