Predictors of early mortality after heart transplantation: the Canadian transplant experience from 1981 to 1992. The CASCADE Investigators. Canadian Study of Cardiac Transplant Atherosclerosis Determinants.

OBJECTIVE: To determine risk factors for early death following transplantation in the Canadian heart transplant experience. METHODS: A retrospective multicentre study of the Canadian experience in heart transplantation was performed to evaluate the role of risk factors of early death within 30 days following transplantation. Eight hundred and thirty-three patients older than 15 years underwent cardiac transplantation between 1981 and 1992 in 10 centres across Canada. The association between risk factors and early mortality was analyzed with a multivariate logistic model to examine simultaneously the effect of all risk factors. RESULTS: Seventy-eight patients (9%) died during the first month following transplantation. Recipient age (P = 0.549), sex (P = 0.554) and body mass (P = 0.313) had no effect. Baseline pulmonary vascular resistance (P < 0.001) and systolic pulmonary pressure (P = 0.021) before transplantation were related to early death. Older donors (P = 0.027) were associated with a higher rate of early death but there was no relation with donor sex (P = 0.597), body mass (P = 0.413), blood group (P = 0.227) and ischemic time (P = 0.309). Patients with pulmonary vascular resistance of 6 or greater (Wood units) and donors older than 50 years had relative risks of early death five and two times, respectively, those of patients without these risk factors. CONCLUSION: Patient survival averaged 91% one month following transplantation in the Canadian experience between 1981 and 1992. The two predictors most strongly correlated with early death were elevated pulmonary vascular resistance at baseline and older donors.