The effects of pre- and post-transplant anemia on 1-year survival after cardiac transplantation.
BACKGROUND
Anemia is associated with a poor prognosis in heart failure. Recent studies have also suggested that anemia may be a predictor of survival after heart transplantation.


METHODS
We investigated whether anemia before or after orthotopic cardiac transplantation affected post-transplant survival and analyzed data from a historical cohort of 267 consecutive adult patients who underwent transplantation between 1994 and 1999. Hemoglobin levels immediately before and at 6 weeks after orthotopic cardiac transplantation were recorded. Anemia was defined as a hemoglobin level less than 12 g/dl. The outcome was all-cause mortality. Survival analysis was performed using the Kaplan-Meier method and Cox proportional hazards models.


RESULTS
Pre-transplant anemia was present in 26% (n= 70). One-year survival was 70% in subjects who were anemic before transplantation compared with 81% in those who were not (p = 0.03). Multivariate analysis showed a 1-year mortality hazard ratio for pre-transplant anemic subjects of 1.77 (95% confidence interval, 1.03 3.0, p = 0.038). Anemia was more prevalent after transplantation (78%). There was no difference in 1-year survival between post-transplant anemic and non-anemic subjects.


CONCLUSIONS
Anemia before, but not after transplantation, is a common independent predictor of 1-year survival in cardiac transplant patients.
Taegtmeyer
Anne B
AB
Transplant Unit, Harefield Hospital, Harefield, Middlesex, United Kingdom.
Rogers
Paula
P
Breen
Jane B
JB
Barton
Paul J
PJ
Banner
Nicholas R
NR
Yacoub
Magdi H
MH
D000328:Adult; D000740:Anemia / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors
D006454:Hemoglobins