Lactic acidosis following heart transplantation: a common phenomenon?
BACKGROUND
Lactic acidosis (LAc) is a common form of metabolic acidosis early after heart transplantation (HTX). The mechanism remains unclear. This study analyzed 13 patients who developed severe LAc after HTX.


METHODS
From a series of 60 consecutive heart transplant patients, we identified 13 patients with LAc in the first hours following HTX. Nine patients with normal or mildly elevated lactate levels (<5.0 mmol/l) were investigated as controls.


RESULTS
Thirteen patients developed a moderate or severe LAc (up to 14.6 mmol/l) after HTX. Serum lactate levels increased immediately following surgery with a peak after 6.3+/-1.4 h, spontaneously returning to normal values within 24 h. In contrast to the control group, a significant correlation was found between the maximal serum lactate level and the maximal dosage of inotropic drugs (r=0.93, P<0.02), administered during the reperfusion phase and continued for 12-24 h postoperatively. No correlation was found between LAc and blood gas analysis during extracorporeal perfusion period.


CONCLUSIONS
LAc can occur after HTX and seems to be related to the inotropic support of the graft. In contrast to other forms, LAc after HTX has an excellent prognosis and resolves rapidly and spontaneously without treatment. The fact that inotropic support during and immediately after cardiac transplantation can enhance preexisting severe peripheral metabolic cellular dysfunction remains hypothetical.
Mohacsi
Paul
P
Cardiology, Swiss Cardiovascular Center Bern, University Hospital (Inselspital), CH-3010, Bern, Switzerland. paul.mohacsi@insel.ch
Pedrazzinia
Giovanni
G
Tanner
Hildegard
H
Tschanz
Hans-Ueli
HU
Hullin
Roger
R
Carrel
Thierry
T
D000140:Acidosis, Lactic / Q000209:etiology*; D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D016027:Heart Transplantation; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D007008:Hypokalemia / Q000209:etiology; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000318:Adrenergic beta-Agonists; D002316:Cardiotonic Agents; D019344:Lactic Acid; D004837:Epinephrine