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COPD in patients after heart transplantation is associated with a prolonged hospital stay, early posttransplant atrial fibrillation, and impaired posttransplant survival

Authors Rivinius R, Helmschrott M, Ruhparwar A, Schmack B, Darche FF, Thomas D, Bruckner T, Katus HA, Ehlermann P, Doesch AO

Received 22 April 2018

Accepted for publication 15 June 2018

Published 27 September 2018 Volume 2018:10 Pages 1359—1369


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Vera Ehrenstein

Rasmus Rivinius,1 Matthias Helmschrott,1 Arjang Ruhparwar,2 Bastian Schmack,2 Fabrice F Darche,1 Dierk Thomas,1 Tom Bruckner,3 Hugo A Katus,1 Philipp Ehlermann,1,* Andreas O Doesch1,4,*

1Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany; 2Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany; 3Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany; 4Department of Pneumology and Oncology, Asklepios Hospital, Bad Salzungen, Germany

*These authors contributed equally to this work

Objectives: COPD is associated with reduced physical activity, an increased risk for pulmonary infections, and impaired survival in nontransplant patients. The aim of this study was to investigate the influence of COPD in patients after heart transplantation (HTX).
Methods: We performed an observational retrospective single-center study of 259 patients receiving HTX at Heidelberg University Hospital between 2003 and 2012. Patients were stratified by the Tiffeneau index (forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC]) <0.70 before HTX. The analysis included demographics, posttransplant medication, length of the initial hospital stay after HTX, early posttransplant atrial fibrillation (AF), mortality, and causes of death.
Results: In total, 63 (24.3%) patients had an FEV1/FVC <0.70. These patients showed a prolonged hospital stay after HTX (52.0 days vs 43.4 days, mean difference (MD) = 8.6 days, 95% CI: 0.2, 17.0 days), a higher rate of early posttransplant AF (19.0% vs 8.2%, MD = 10.8%, 95% CI: 0.4%, 21.2%), and an increased 30-day mortality (9.5% vs 2.6%, HR = 3.79, 95% CI: 1.16, 12.40). Kaplan–Meier analysis showed a significant inferior 5-year survival in patients with an FEV1/FVC <0.70, along with a higher percentage of death due to transplant failure and infection/sepsis. In addition, a multivariate analysis for mortality within 5 years after HTX indicated an FEV1/FVC <0.70 as a significant risk factor for impaired 5-year posttransplant survival (HR =4.77, 95% CI: 2.76, 8.22).
Conclusion: COPD in patients after HTX is associated with a prolonged hospital stay, early posttransplant AF, and impaired posttransplant survival.

Keywords: atrial fibrillation, COPD, heart transplantation, mortality, spirometry, Tiffeneau index

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