Ischemic Time as a Predictor of Physical Recovery in the First Months after Heart Transplantation

Abstract

Functional results after heart transplantation range from modest to spectacular improvement. Little is known about factors to predict functional result. This study aimed to identify these factors. We present a prospective study including all consecutive transplant recipients (n = 55) in a two-year period whose survival was greater than two months. Perioperative, donor, and recipient issues were systematically analyzed. Exercise capacity was assessed by symptom-limited treadmill exercise testing two months after transplantation. Exercise capacity was classified as satisfactory or poor depending on achieving or not 4.5 METs (metabolic equivalents), respectively. Thirty-three patients (60%) showed a good exercise capacity (>4.5 METs), whereas the remaining twenty-two patients (40%) were unable to exceed this threshold. The variables which correlated with exercise capacity in univariate analysis were recipient age, inotropic treatment, ischemic time, ventricular assist device, etiology, urgent transplant, and INTERMACS score. Among them only recipient age and ischemic time were proved to be correlated with exercise capacity in the multiple regression analysis. Thus, younger patients and those who had received an organ with shorter ischemic time showed greater exercise capacity after transplant. These findings strengthen the trend toward reducing ischemic time as much as possible to improve both survival and clinical recovery.

Impact of Ischemic Time on Functional Exercise Capacity after Orthotopic Heart Transplantation

“…al., regarding donor and recipient specific qualities that impact functional recovery in the 2 months following transplant. 16 This discrepancy may be in part due to the method used to test and evaluate OHT recipients. Those investigators, used the Bruce treadmill protocol, which utilizes steep incline and speed increases each progressing stage.…”

“…17 The RPE-CR10 (1 to 10) scale is a common method for determining exercise intensity levels, where "0" = nothing at all and "10" = very, very hard. The traditional Borg scale (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) was not used due to the disassociation between level of difficulty and heart rate seen in a denervated heart. Continuous blood pressure (BP) measurements were taken to ensure hemodynamic stability and lead II ECG was monitored continuously by telemetry staff.…”

“…FEC is a significant component in an individual's ability to perform activities of daily living, participate in recreational and occupational ventures and is associated with QOL after OHT 2. Low QOL has been associated with increased symptoms of depression and anxiety in OHT recipients16 , which makes it imperative for healthcare professionals to understand the impact prolonged IT may have on the recipient's prognosis.Given that increased IT may impact cardiac functioning following adult OHT, the impact of IT on FEC should warrants further investigation in order to further understand the implications of using donor hearts with extended IT. In one landmark study, shorter IT was related to increased FEC in OHT recipients two months post-transplant, but this study was not sensitive to the variable needs of the OHT patient population 16.…”

The effect of donor ischemic time on mortality in heart transplanted patients

“…[6,7] Graft dysfunction due to prolonged donor ischemic time, which may lead to an increased need for inotropic agents as well as postoperative VAD implantation, has not only been linked to mortality but has also been connected with a decrease in the early postoperative functional capacity of recipients. [8] Several studies have also reported reduced survival rates in patients with prolonged donor ischemic time, [4,6,[9][10][11] but other studies have not shown any connection. [1,12,13] Kilic et al [11] studied 9,404 patients who underwent an orthotopic heart transplantation from 1987 to 1999 and concluded that younger patient age (<55 years), a shorter donor ischemic time, and younger donor age were the most important factors for predicting the 10-year survival rate after cardiac transplantation.…”

Experience of heart transplantation with an extended cold ischemic time of donor heart

“…По данным многих исследований, непосредственные и отдаленные результаты ОТС с короткой и длительной ишемией донорского сердца сопоставимы [8][9][10][11], что согласуется с нашими данными. Однофакторный регрессионный анализ не выявил влияние длительности холодовой ишемии на госпитальную выживаемость.…”