title: Extreme Hyperlactatemia After Heart Transplantation: One Center's Experience.
abstract: BACKGROUND
  Hyperlactatemia may occur early after cardiac surgery and is correlated with prognosis. This study was conducted to analyze the perioperative variables and postoperative outcomes among heart transplant recipients with extremely high lactate levels (>15 mmol/L).
  
  
  METHODS
  The single-center medical records of heart transplantation from June 2006 to May 2013 were retrospectively reviewed for patient characteristics, perioperative hemodynamic variables, arterial blood gas analysis data, and postoperative mortality.
  
  
  RESULTS
  Among 58 consecutive heart transplant recipients, lactate levels over the detectable upper limit (>15 mmol/L) were identified in 12 patients after intensive care unit admission, with peak time at 1.9 ± 2.0 (range 0-6.1) hours. The maximal preoperative lactate level was 3.1 mmol/L, and most (11/12) postoperative lactate levels returned to <4 mmol/L at 27.5 ± 12.8 hours after surgery (range 15-58, median 24), displaying a trend toward delayed extubation time in 10 recipients (P < .01). Blood glucose levels elevated significantly from preoperative 148.9 ± 45.2 to 375.7 ± 96.9 mg/dL at peak lactate level (P < .01). Four patients died in the ICU (range 5-32 days), 4 died after discharge (range 5-57 months), with 6 in total surviving over 1 year.
  
  
  CONCLUSIONS
  Extreme hyperlactatemia commonly occurred early after heart transplantation and mostly recovered within 30 hours; however, with delayed extubation time after operation.
authors: Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Y C
authors: YC
authors: Hsu
authors: Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: C H
authors: CH
authors: Hsu
authors: Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: G S
authors: GS
authors: Huang
authors: Department of Anesthesiology, Taipei Veterans General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: C C
authors: CC
authors: Lu
authors: Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Z F
authors: ZF
authors: Wu
authors: Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Y T
authors: YT
authors: Tsai
authors: Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: C Y
authors: CY
authors: Lin
authors: Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
authors: Y C
authors: YC
authors: Lin
authors: Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: C S
authors: CS
authors: Tsai
authors: Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: tclin@ndmctsgh.edu.tw.
authors: T C
authors: TC
authors: Lin
mesh_terms: D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D065906:Hyperlactatemia / Q000097:blood / Q000401:mortality; D007362:Intensive Care Units / Q000706:statistics & numerical data; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D019344:Lactic Acid