Incidencia y predictores de complicaciones graves tras el trasplantecardiaco en la Unidad de Reanimación / Major complications in the recovery unit following heart transplant: incidence and risk factors

RESUMEN

OBJETIVO: Determinar las complicaciones durante elpostoperatorio en Reanimación y analizar qué variablesdel receptor, donante y quirúrgicas se asocian a complicacionesmayores.MATERIAL Y MÉTODO: Analizamos una serie de trasplantescardiacos ortotópicos consecutivos realizados ennuestro centro entre 2001-2007. Se compararon pacientesque no presentaron complicaciones mayores (CM) durantela estancia en Reanimación (Grupo 1) con los que sí lasdesarrollaron (Grupo 2). Se consideró CM el exitus, falloprimario del injerto (FPI), infección grave y necesidad dehemodiálisis.RESULTADOS: Incluimos 152 pacientes cuyo tiempo depermanencia en Reanimación fue de 3 (2,25-5) días. Cientotrece pacientes no presentaron CM en Reanimación(Grupo 1), mientras que 39 pacientes (26%) sí desarrollaroncomplicaciones (Grupo 2) FPI (20%), infección (12%)y disfunción renal grave (5,3%). Observamos diferenciassignificativas entre los grupos respecto a edad (50 ± 12 vs55 ± 6; p = 0,001), diabetes (14 vs. 41%; p = 0,0001), clasefuncional New York Heart Association IV/IV (34 vs. 54%;p = 0,04), trasplante urgente (18 vs 46%; p = 0,001), tiempode circulación extracorpórea (119 ± 35 vs. 145 ± 66minutos; p = 0,03), balón de contrapulsación pretrasplante(6 vs 15%; p = 0,04). El análisis multivariado demostróasociación entre las CM y el trasplante urgente (OR 5,67;p = 0,001), receptor mayor de 55 años (OR 2,99;p = 0,027) y diabético (OR 2,86; p = 0,048).CONCLUSIONES: Un 26% de los pacientes cardiacosdesarrollaron CM en Reanimación. Las más frecuentesfueron el FPI, la infección y la disfunción renal grave. Sonvariables predictivas independientes de su aparición eltrasplante urgente, edad y diabetes mellitus del receptor (AU)

ABSTRACT

OBJECTIVE: To assess the incidence of majorcomplications in the postoperative recovery unit andto analyze the associated recipient, donor, and surgicalrisk factors.MATERIAL AND METHODS: We studied a series ofconsecutive orthotopic heart transplants carried out inour hospital from 2001 through 2007. Patients whoexperienced major complications during their stay in therecovery ward were compared with those who did not.Exitus, primary graft failure, severe infection, and needfor hemodialysis were considered major complications.RESULTS: One hundred fifty-two patients were enrolled.The mean stay in the recovery unit was 3 days (range,2.25-5 days). Thirty-nine patients (26%) developed majorcomplications in the recovery unit and 113 did not. Thecomplications were primary graft failure (20%), infection(12%), and acute renal failure (5.3%). Patients with andwithout major complications were significantly differentwith respect to mean (SD) age (55 [6] vs 50 [12] years,respectively; P=.001), presence of diabetes mellitus (41%vs 14%, P=.0001), classification in New York HeartAssociation functional class IV/IV status (54% vs 34%,P=.05), emergency transplantation (46% vs 18%, P=.001),mean cardiopulmonary bypass time (145 [66] vs 119 [35],P=.03), pretransplant use of an intra-aortic balloon pump(15% vs 6%, P=.04). Multivariate analysis demonstratedan association between major complications andemergency transplantation (OR, 5.67; P=.001), recipientage over 55 years (OR, 2.99; P=.027), and diabetesmellitus (OR, 2.86; P=.048).CONCLUSIONS: The incidence of major complicationsin our postoperative recovery unit was 26%. The mostcommon complications were primary graft failure,infection, and acute renal failure. Emergencytransplantation, older age, and a diagnosis of diabetesmellitus in the recipient were predictors of complication (AU)