Authors: Mansour A et al.
Anesthesiology. January 13, 2026.
Summary
This multicenter observational study examined the incidence, risk factors, and clinical consequences of severe postoperative bleeding following adult heart transplantation. Although bleeding is a well-recognized complication in cardiac surgery, data specific to heart transplantation have been limited. The authors sought to better define the burden of severe hemorrhagic complications and their impact on outcomes in this high-risk population.
All adult patients undergoing heart transplantation between 2015 and 2022 at two French referral centers were included, for a total of 446 patients. Severe postoperative bleeding was defined using a Universal Definition of Perioperative Bleeding (UDPB) score of 3 or greater. Multivariable logistic regression was used to identify factors associated with severe bleeding, and multivariable Cox regression assessed its association with one-year mortality.
Severe postoperative bleeding occurred in 25% of transplant recipients. In adjusted analyses, long-term mechanical circulatory support before transplantation was independently associated with higher odds of severe bleeding. Lower preoperative hemoglobin levels and longer cardiopulmonary bypass duration were also significant contributors. Importantly, severe bleeding was not merely a perioperative complication but carried major downstream consequences. Patients with severe bleeding had substantially higher one-year mortality compared with those without severe bleeding, even after adjustment for confounders.
These findings highlight severe postoperative bleeding as a common and clinically meaningful complication after heart transplantation, with clear implications for both short- and long-term outcomes. The association with modifiable and potentially identifiable risk factors underscores the need for improved perioperative risk stratification and bleeding prevention strategies in this population.
What You Should Know
Severe postoperative bleeding occurs in approximately one in four adult heart transplant recipients.
Mechanical circulatory support prior to transplantation, lower preoperative hemoglobin, and longer cardiopulmonary bypass times increase bleeding risk.
Severe bleeding is independently associated with nearly doubled one-year mortality.
Enhanced bleeding prevention and perioperative management strategies may meaningfully improve outcomes after heart transplantation.
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