Are patients undergoing heart transplantation (HTx) getting worse today?

Aims: Patients are referred later to HTx due to advances in medical management of heart failure. The aim of this study was to evaluate the impact of the secondary end organ dysfunction as a marker of right heart failure at the date of transplantation on outcome over a 5-year time period.

Methods: Since 2000, 60 HTx-recipients were included in this retrospective analysis. Creatinine and bilirubin values and the need for postoperative hemodialysis as marker of cardiac secondary organ function and clinical outcome were assessed.

Results: Although there was an inconsistent trend in the development of bilirubine, preoperative mean creatinine-values increased significantly during follow-up. Therefore, incidence and duration of hemodialysis therapy increased steadily. ICU-stay increased whether mortality remained unchanged.

	2000	2001	2002	2003	2004	Stat. Significance (p)
creatinine preop [umol/l]	70±29	107±41	118±32	147±86	206±99	0.003
creatinine postop [umol/l]	189±167	191±157	180±110	256±164	301±152	0.06
hemodialysis preop [n]	0.±0.3	0	0	0.12±0.35	0.25±0.38	0.19
hemodialysis postop [n]	0.2±0.4	0.25±0.45	0.2±0.4	0.75±0.46	1.02±0.24	0.002
Bilirubin preop [umol/l]	24±12	18±10	22±13	28±15	35±16	0.14
Bilirubin postop [umol/l]	32±40	20±15	23±15	29±25	25±10	0.8
ICU-stay [d]	4.6±5.5	6.1±5.8	7.0±5.9	8.4±4.2	9.8±5.5	0.01

Conclusion: Pretransplant deterioration of secondary organ function steadily increased recently. Therefore incidence of postoperative hemodialysis and prolonged ICU-stay increased not affecting perioperative mortality. Whether the delayed patient's referral to the transplant center has an impact on long-term outcome after HTx has to be awaited. Perioperative resources needed for HTx-patients are higher nowadays.