Intraoperative hemoglobin level and primary graft dysfunction in adult heart transplantation

Objectives We investigated the association between recipient serum hemoglobin and primary graft dysfunction after heart transplantation. Methods We retrospectively evaluated adult patients who underwent heart transplantation at our institution from 2007 to 2016. Patients were grouped into three quantiles based on serum hemoglobin level at the time of donor heart reperfusion. Primary graft dysfunction was analyzed in each quantile. Results We assessed 69 patients, and 12 showed primary graft dysfunction. The mean hemoglobin levels at reperfusion in the low, middle, and high hemoglobin quantiles were 7.6 ± 0.9, 9.2 ± 0.3, and 10.4 ± 0.6 mg/dL, respectively. There were no significant between-group differences in pre-heart transplantation serum hemoglobin levels ( p = 0.53). The odds ratio for primary graft dysfunction was significantly higher in the low hemoglobin quantile (5.80; 95% confidence interval, 2.32–14.5; p < 0.001) than in the middle (1.14; 95% confidence interval, 0.40–3.23) and high (reference) hemoglobin quantiles. The odds ratios for primary graft dysfunction in the three quantiles based on pre-heart transplantation hemoglobin levels did not differ significantly. Conclusions Low recipient serum hemoglobin levels at the time of donor heart reperfusion was independently associated with primary graft dysfunction after heart transplantation. Intraoperative management of recipient hemoglobin using red blood cell transfusion may prevent post-heart transplantation primary graft dysfunction.