Emerging Perspectives in TransplantationThoracic transplantationExtreme Hyperlactatemia After Heart Transplantation: One Center's Experience

•Hyperlactatemia may occur early after cardiac surgery.•We identified 12 from 58 consecutive heart transplant recipients developing severe hyperlactatemia (>15 mmol/L) soon after arriving in the intensive care unit.•Most lactate levels spontaneously returned to <4 mmol/L within 30 hours and were correlated with delayed extubation time.•Four patients expired in the ICU, 4 expired after discharge and 6 in total survived over 1 year.

IntroductionHyperlactatemia 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).MethodsThe 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.ResultsAmong 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.ConclusionExtreme hyperlactatemia commonly occurred early after heart transplantation and mostly recovered within 30 hours; however, with delayed extubation time after operation.