Multiorgan failure is a contraindication to heart transplantation (HT). In Spain, standardized criteria have been established for its definition. The aim of this study was to analyze the association between these criteria, assessed at urgent waiting list inclusion and at the time of transplantation, and in-hospital mortality (IHM).

Ambispective multicenter study of consecutive urgent HT procedures performed between January 2020 and May 2024. We excluded patients aged <17 years, those with multiorgan transplants, and retransplant recipients (n=328). Data from the Spanish Heart Transplant Registry and the following multiorgan failure-related variables, collected at both time points, were analyzed: Sequential Organ Failure Assessment (SOFA) score, renal replacement therapy, mechanical ventilation (MV), myopathy (Medical Research Council [MRC] scale), and vasoactive-inotropic score (VIS).

At inclusion, 62.5% of the patients had a SOFA score of 0-5 and 3.4%> 11; at transplantation, these proportions were 69.2% and 4.0%, respectively, with a reduction in SOFA score during the waiting period (P <.001). Eighty percent of patients did not require MV at either time point, and 10.3% received MV for> 7 days at transplantation. Myopathy worsened during the waiting period, with a 3.7% increase in patients with MRC <36 (P=.003), with no changes in VIS (P=.230). IHM was associated with duration of MV at inclusion (OR, 1.05; 95%CI, 1.01-1.10; P=.030) and at transplantation (OR, 1.03; 95%CI, 1.00-1.07; P=.050), and with a SOFA score of 6-11 (vs 0-5) at the time of transplantation (OR, 2.13; 95%CI, 1.03-4.38; P=.040).

In urgent HT, MV and higher SOFA scores at the time of transplantation are associated with increased IHM.