PERICARDIAL-EFFUSIONS AFTER CARDIAC TRANSPLANTATION

Objectives. The aim of this study was to determine the etiologic facto rs in the formation of significant pericardial effusion after orthotop ic heart transplantation and to determine the association of pericardi al effusion with survival. Background. The formation of pericardial ef fusions has been well described after orthotopic heart transplantation , but the risk factors for development of effusions remain unclear. Re jection and cyclosporine have been cited as possible causes, but anato mic factors have not been studied. Methods. We conducted a retrospecti ve review of medical records and echocardiograms of 203 consecutive pa tients at one center, including ischemic time, incidence and severity of rejection, weight difference between donor and recipient and previo us cardiac surgical history. Multivariate analysis was performed, and actuarial survival rate curves were calculated according to the Kaplan -Meier method. Results. Eighteen (8.9%) of 203 transplant recipients d eveloped moderate to large pericardial effusions. Forty-four percent o f patients required pericardiocentesis, and 28% subsequently required pericardiectomy for management of the effusions. Multivariate analysis identified the presence of a positive weight difference between recip ient and donor (recipient weight > donor weight) and the lack of previ ous median sternotomy as the most powerful predictors of effusion form ation. No significant association was found with rejection. There was no difference in actuarial survival rate between patients with and wit hout effusions. Conclusions. A positive mismatch in weight between rec ipient and donor and-the absence of previous cardiac surgery are assoc iated with the formation of significant pericardial effusions. Closer monitoring of these patients at risk may be warranted.