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| - Introduction : La transplantation cardiaque est une thérapeutique d’exception dont les résultats varient considérablement en fonction de nombreuses variables pronostiques. En période de pénurie d’organe, il apparait indispensable d’évaluer les résultats cliniques dans ce domaine. Matériel et Méthode : Nous avons élaboré une base rennaise de transplantation (TransplantR) afin d’évaluer les résultats de la greffe cardiaque au CHU de rennes de 2008 à 2018 et d’individualiser les variables pronostiques pour le décès en réanimation et la dysfonction primaire sévère de greffon. Résultats : 223 patients ont été inclus dans la base. La mortalité en réanimation était de 15,7%. Les variables qui y étaient significativement associés en analyse multivariée sont la cardiopathie radique (OR 10,967 [1,580; 76,136]), le stade INTERMACS 1 (OR 8,938 [1,255; 63,676]), l’ECMO et le LVAD (OR 3,340 [1,061; 10,517] et 3,163 [1,103; 9,070]), les geste associés ou compliqués (OR 3,179 [1,017; 9,940]), la chirurgie redux (OR 2,934 [1,220; 7,058]), le nombre de missmatch HLA (OR 1,389 [1,010; 1,911]), l’ancienneté de l’insuffisance cardiaque (OR 1,061 [1,004 ; 1,121]), la PVC (OR 1,108 [1,021; 1,203]), la bilirubinémie totale (OR 1,052 [1,013; 1,092]), l’âge (OR 1,040 [1,001; 1,080]), la dose de noradrénaline du donneur (OR 3,105 [1,297; 7,432]) et le DTDVG du donneur (OR 1,083 [1,010; 1,162]). L’incidence de dysfonction primaire de greffon était de 29,1%. Les variables qui y étaient significativement associés en analyse multivariée sont le Ratio diamètre Ao/Ap (OR 36,985 [3,61; 378,37]), l’ECMO (OR 5,174 [1,207; 22,185]), la cardiopathie ischémique (OR 2,324 [1,102; 4,901]), la transfusion de CGR (OR 1,158 [1,054; 1,272]), la PAPm (OR 1,076 [1,024; 1,131]), la PVC (OR 1,071 [1,005; 1,142]), la dose de noradrénaline du donneur (OR 2,375 [1,053; 5,354]) et le décès par traumatisme crânien (OR 1,938 [1,034; 3,632]). Conclusion : Une base de données dédiée à la transplantation cardiaque au CHU de Rennes (TransplantR) a été mise en place. Ce travail nous a permis d’individualiser de nombreux facteurs pronostiques de décès en réanimation et de dysfonction primaire sévère de greffon dont certains non précédemment décrit dans la littérature.
- Introduction : Heart transplantation is an exeption therapy which results vary depending on many prognostic variables. In times of organ shortage, it seems essential to evaluate its clinical results. Material and methods : We have developed a transplantation database in Rennes (TransplantR) to evaluate the results of cardiac transplantation in our university hospital from 2008 to 2018 and to individualize the prognostic variables for death in intensive care unit and severe primary graft dysfunction. Results : 223 patients were included in the database. The mortality in intensive care unit was 15.7%. The variables that were significantly associated with in multivariate analysis are radiation heart disease (OR 10,967 [1,580; 76,136]), INTERMACS 1 (OR 8,938 [1,255; 63,676]), ECMO and LVAD (OR 3,340 [1,061; 10,517] and 3,163 [1,103; 9,070]), the associated or complicated gestures (OR 3,179 [1,017; 9,940]), redux surgery (OR 2,934 [1,220; 7,058]), the number of HLA missmatch (OR 1,389 [1,010; 1,911]), the duration of heart failure (OR 1,061 [1,004; 1,121]), central venous pressure (OR 1,108 [1,021; 1,203]), total bilirubinemia (OR 1,052 [1,013; 1,092]), age (OR 1.040 [1.001, 1.080]), the donor noradrenaline dose (OR 3.105 [1.297, 7.432]) and donor’s left ventricle diastolic diameter (OR 1.083 [1.010, 1.162]). The incidence of primary graft dysfunction was 29.1%. The variables that were significantly associated with in multivariate analysis are the Aorta / Pulmonary artery diameter ratio (OR 36.985 [3.61, 378.37]), ECMO (OR 5.174 [1.207, 22.185]), ischemic heart disease (OR 2.324 [1,102; 4,901]), transfusion (OR 1,158 [1,054; 1,272]), PAPm (OR 1,076 [1,024; 1,131]), central venous pressure (OR 1,071 [1,005; 1,142]), donor noradrenaline (OR 2,375 [1,053; 5,354]) and death by head injury (OR 1,938 [1,034; 3,632]). Conclusion : A database dedicated to heart transplantation at Rennes University Hospital (TransplantR) has been set up. This work allowed us to individualize many prognostic factors of death in intensive care and severe primary graft dysfunction, some of which were not previously described in the literature.
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