1 / 14

DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION.

DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION. C Amarelli, LS De Santo, M Buonocore , A Carozza , A Della Corte, MV Montibello , C Maiello , G Romano Monaldi Hospital -Azienda Ospedaliera dei Colli - Naples (IT).

istas
Download Presentation

DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION. C Amarelli, LS De Santo, M Buonocore, A Carozza, A Della Corte, MV Montibello, C Maiello, G Romano MonaldiHospital -Azienda Ospedaliera dei Colli - Naples (IT)

  2. DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION. • Few data regarding blood product transfusion during Heart Transplantation have been published. • Prognostic role of Blood Products in Cardiac Surgery is now matter of debate.

  3. DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION. The increasing number of patients with increased risk of bleeding and blood product transfusion (i.e. Redo, VAD, Patient under dual antiplatelet therapy, etc) requires a debate on Blood Product Management in Heart Transplantation.

  4. DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION.

  5. DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION. • Study Aim: • Define the incidence, risk factors and prognostic implication related to blood products transfusion in a single-center cohort operated on between January 1999 and December 2010. • Data from 362 consecutive recipients (mean age: 47.5±13.6, 20.2% female, 21.5% with previous cardiac operations) were analyzed.

  6. DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION. • Patient blood management was characterized along with prognostic implication of each product exerted on • Acute Kidney Injury (AKI, defined according to RIFLE criteria), • Primary Graft Failure(PGF), • Multi Organ Failure(MOF), • 1-year Acute Rejection • 1-year Glomerular Filtration Rate (GFR).

  7. DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION.

  8. DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION. • Only 35.2% of patients did not received any blood product transfusion; mean number of units of red packed cells trasfused was 2.87+4.96. • Previous sternotomy (82.9%vs59.1%; p<.001; 6.04±7.99 units for patient) and post-valvular etiology (82.6%vs62%; p<.001; 3.96±2.96units) were associated with a significantly higher risk and number of transfusion. • in-hospital patients had similar incidence of transfusion (69.9%vs62.6%) despite receiving an increased number of units (4.16±6.44 vs 2.18±3.25).

  9. DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION.

  10. DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION. • Transfused patients had a significantly higher risk of AKI>50% (4%vs17,5%;p<.001), MOF (1.8%vs13.7%;p<.001) and hospital mortality (4.1%vs12,6%;p=.01); a clear dose dependency was disclosed. • The transfused patients who survived operation had a lower risk of acute rejection (also after a leukoreduction program has been implemented) and no differences in 1-year GFR with non-trasfused.

  11. DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION.

  12. DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION. • Patient blood management is a marker of risk rather than the direct determinant of poor outcome. • However programs on Blood Product Management in HT should be implemented to optimize results especially when high risk patients for bleeding have to be managed. • Redo Patients, Low GFR patients, and in general frail patients should be always managed keeping in mind the reduction of Blood product usage and the prevention of AKI, EGF and MOF.

  13. DETERMINANTS AND PROGNOSTIC VALUE OF PATIENT BLOOD MANAGEMENT IN HEART TRANSPLANTATION. A clear relationship between transfusion, early post-transplant morbidity and mortality emerged. Patient blood management should be taken in account when tailoring immunosuppression in the early postoperative period. Despite the statistical evidence, in consideration of the high number of confounding factors, the reduced incidence of Rejection in transfused patients should be further investigated looking the relationship between BP and tests to assess the global immunologic status.

More Related