| Objective:To investigate the relationship between early troponin levels after heart transplantation and in-hospital matality of the patients.Methods:This retrospective investigation analyses 480 patient cases of Fuwai hospital. First, using ROC curve to find the cut-off point of post-operative early (from the operation day to the third day after operation) toponin I(TnI)levels and preditctions of in-hospital mortality, according to the cut-off point, patients were divided into low TnI group and high TnI group;baseline data, post-operative recovery condition and in-hospital suivival were compared. Using logistic regression analysis to determine the risk factors affecting in-hospital mortality after heart transplant. Results:Median TnI levels of operative day and the fist three days after operation was 30.3ng/ml,24.6ng/ml,14.5ng/ml and 7.7ng/ml respectively. TnI levels of operative day and the fist three days after operation had some predictive value for in-hospital mortality. For the first post-operative day, the cut-off value of TnI to predict in-hospital mortality is 51.9ng/ml, with a sensitivity of 73.3% and a specificity of 81.1%. For the second post-operative day, the values are 40.Ong/ml,63.4% and 89.5% separately. For the third post-operative day, the values are 17.Ong/ml,73.3%,82.3% separately. Low TnI group (<40ng/ml) accounted for 87.8%, while high TnI group accounted 12.2%. Compared with low TnI group, high TnI group showed higher level of pre-operative serum creatinine (101.6±30.4 vs.91.2± 27. lumol/L,P<0.05), NT-proBNP (10.6±7.0 vs.7.9±6.1, P<0.05) and bigger donor weight (70.2±7.3 vs.67.7±8.6kg, P<0.05), as well as longer cold ischemia time (396.9±125.3 vs.324.2±125. Omin, P< 0.05) and larger percentage of cold ischemia time≥6 hours (70.9% vs.42.3%, P< 0.05). Correlation analysis showed certain correlation between TnI levels from the day of operation to the third after operation and cold ischemic time(P< 0.01). As to the comparation of postoperative recovery, the high TnI group showed longer ventilation time (57.0 vs.20. Oh P<0.05)and average Intensive Care Unit stay(7.5 vs.3.6d P<0.05). At the same time, the utility ratio of mechanical circulatory assist devices(CRRT/ECMO/IABP) in the high Tnl group is higher than low TnI group(P<0.05). Univariate Logistic regression analysis showed that Tnl of the second day after operation≥40ng/ml, the Tnl level of the second and third day after operation, previous history of heart transplantation, history of pre-operative ECMO application, pre-operative serum creatinine, total bilirubin level, the multiples of NT-proBNP rise, mean pulmonary arterial pressure measured by Swan-Ganz catheter were risk factors for in-hospital mortality of patients with heart transplantation. After eliminating other factors using multivariate Logistic regression model, it proved that Tnl level of the second day after operation≥40ng/ml(OR=18.750,95%CI,1.644-213.900), preoperative serum creatinine (OR=1.016,95%CI,1.001-1.031) and total bilirubin level (OR=1.068,95%CI,1.022-1.115)were the major risk factors for in-hospital mortality of the patient population in this study. Conclusion:The Tnl levels of the first 1-3 days after heart transplantation show certain prediction value for in-hospital mortality of heart transplantation. TnI of the second post-operative day≥40ng/ml is an important risk factor for in-hospital mortality of heart transplantation patients.Objective:To explore the influence of recipient gender on survival condition in patients after heart transplantation (HT) by retrospectively analyzing 439 consecutive recipients from a single center for 10 years. Methods:A total of 439 consecutive patients who received HT in our hospital from 2004-06 to 2014-06 were retrospectively studied. The clinical data at before and after HT with the follow-up condition were summarized. The patients were divided into 2 groups:Female group, n=76 and Male group, n=363. Pre-operative risk factors and the endocardial myocardial biopsy (EMB) monitored pathological grading score for rejection were analyzed by SPSS17.0 software. The survival curve was made by Kaplan-Meier method and the comparison of survival condition was conducted by log-rank test for both groups. Lastly, using COX regression analysis to determine the risk factors affecting midterm cardiac mortality after heart transplant. Results: Compared with Male group, the patients in Female group had the younger age, (P=0.027); lower height and BMI(P<0.05); more pre-operative cardiomyopathy and lower level of pre-operative serum creatinine(all P<0.001). While the utility ratio of pre-operative extracorporeal membrane oxygenation (ECMO), total level ofbilirubin, positive rate of population reactive antibody (PRA), mismatch number in A-point of human leukocyte surface antigen (HLA) were similar between 2 groups, all P>0.05. EMB was performed in 42/76 (55.3%) female and 193/363 (53.2%) male recipients, the pathological grading scores for rejection were similar between 2 groups among 1 month,>1 month≤3 months,>3 months≤ 6months and> 6months≤ 12 months, all P>0.05. The followup study presented that the survival rate in Female group and Male group at different time points were similar, as at 1 year (96.0% vs 94.2%), 3 years (92.2% vs 91.5%),5 years (89.1% vs 88.5%) and 7 years (86.0% vs 81.0%) respectively. Log-rank test showed that the survival condition was similar between 2 groups, P>0.05. Univariate COX regression analysis showed that the recipients gender had no significant influence on midterm cadiac deaths;post operative creatinine level(HR=1.010,95% CI,1.001-1.019), positive rate of population reactive antibody (HR=3.740,95% CI, 0.060-13.197), troponin I level of the second (HR=1.025,95% CI,1.002-1.049) and third day after the operation (HR=1.040,95%CI,1.011-1.070) were major risk factors affecting midterm cadiac deaths, (P<0.05). After eliminating other factors using multivariate COX regression model, it could be proved that positive rate of population reactive antibody (HR=28.937,95%CI, 3.655-229.104) was the major risk factors for midterm cadiac deaths of the patient population in this study. Conclusion:Cardiomyopathy is the main etiology in Chinese HT recipients. Based on the situation that major donors are male subjects, the recipient gender has no significant influence on post-operative rejection and midterm survival condition.
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