PROGNOSTIC DETERMINANTS OF 6-MONTH MORBIDITY AND MORTALITY IN HEART-TRANSPLANT RECIPIENTS

Background: Knowledge of time course and risk factors for morbidity an d mortality may allow better cardiac graft allocation, surveillance ti ming, and planning of immunosuppressive strategies. Methods: Six-month morbidity and mortality were retrospectively analyzed in a multiinsti tutional series of 645 heart transplant recipients. Results: During a 3432 patient-months follow-up, 87 patients died of infection (n = 11), rejection (n = 11), multiorgan failure (n = 9) and other transplant-r elated causes (n = 56); six-month survival rate was 86%. Three hundred thirty-seven recipients had 967 treated rejection episodes (2.87 epis odes/patient with rejection, lethality 3.2%); 223 major infectious epi sodes occurred in 162 patients (1.38 episodes/infected patient, lethal ity 7%). Six-month rejection and infection-free survival rates were 44 % and 73%. Total mortality and cause-specific morbidity sharply declin ed after the first month; 160 patients (25%) had no events during foll ow-up. At multivariable analysis, significant risk factors for mortali ty were postoperative acute kidney failure, prolonged cardiopulmonary bypass time, and previous cardiac surgery. Rejection was associated wi th steroid-free and globulin-free immunosuppression and infection was associated with steroid immunosuppression, cytolytic treatment, venous lines placement greater than 7 days, and mechanical ventilation time. No single or combination of variables was able to discriminate patien ts with an event-free course. Conclusions: Morbidity and mortality hav e the highest incidence during the early posttransplantation phase. Pr eoperative variables are of limited value with respect to immunosuppre ssive treatment in predicting outcome. Infection is far less frequent than rejection but, in view of the higher lethality rate, deserves a v igourous effort for prevention, which is best addressed by appropriate modulation of immunosuppressive strategies.