Clinical significance and survival analysis of hyperbilirubinemia after heart transplantation

Xingyu WANG; Xiang WEI

ABSTRACT

Objective:

To explore the postoperative hyperbilirubinemia after heart transplantation(HT)and examine its related in-hospital mortality and long-term survival status.And the relationships between preoperative pulmonary hypertension or postoperative right heart dysfunction and hyperbilirubinemia are also elucidated.

Methods:

From 2014 to 2021, the relevant perioperative data are retrospectively reviewed for 142 HT recipients at Tongji Hospital of Tongji Medical College of Huazhong University of Science & Technology.Based upon the presence or absence of postoperative bilirubin, they were divided into two groups of hyperbilirubinemia(group A, 73 cases) and non-hyperbilirubinemia(group B, 69 cases). And the correlation between preoperative pulmonary hypertension, postoperative right ventricular dysfunction and postoperative hyperbilirubinemia is examined by contingency table; Kaplan-Meier survival curve of postoperative hyperbilirubinemia is plotted.

Results:

This cohort is composed of 109 males(76.76%)and 33 females(23.24%)with an average age of(47.01±15.31)years.Hyperbilirubinemia occurred in 51.41% of recipients.Logistic analysis revealed in-patient mortality become markedly elevated in hyperbilirubinemia group (OR 3.855; 95% CI 1.202~12.367). However, no significant difference existed in 8-year survival curve post-transplant( P=0.09). For group A, 24 cases(32.87%)have pulmonary hypertension pre-operation and duration of CPB was(188.15±63.18)min, 37 and 30 cases(50.68%, 1.67%)have either right or left ventricular dysfunction post-operation.Intra-aortic balloon pump(IABP, 17cases, 23.29%)and extracorporeal membrane oxygenation(ECMO, 11 cases, 15.07%)are employed.The above parameters are all higher in group A than those in group B.

Conclusions:

The incidence of postoperative hyperbilirubinemia and related in-hospital mortality remains high after HT.However, no significant difference exists in medium/long-term survival rate after adequate treatment.Preoperative pulmonary hypertension and postoperative right heart dysfuncion are associated with hyperbilirubinemia postoperatively.Clinical interventions for risk factors of hyperbilirubinemia are required during perioperative period.