SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Heart Failure and Transplantation
Lactate Clearance and Mortality After Heart Transplantation: A Systematic Review And Meta-Analysis
Francisco José Romeo 1
Mohammad Ishrak Khan 2
Efrain Miguel Castillo Córdoba 1
Monica Devaraju 1
Leandro Barbagelata 3
Marta Lorente-Ros 4
José Salvador Aguilar-Gallardo 5
Walter Masson 3
1. University of Miami Miller School of Medicine, Miami, United States
2. Deborah Heart and Lung Center, Browns Mills, United States
3. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
4. MedStar Washington Hospital Center, Washington, United States
5. Tulane University School of Medicine, New Orleans, United States
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Abstract
Abstract Background Lactate clearance (LC) has been associated with outcomes in several critically ill populations, including septic shock, cardiogenic shock, and patients requiring intensive care. Despite this, there are few validated dynamic biomarkers to support early risk stratification after heart transplantation (HTX), and the prognostic relevance of LC in this setting remains uncertain. Methods We performed a systematic review and meta-analysis following the PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, ScienceDirect, and the Cochrane Central Register of Controlled Trials were searched from database inception to March 10, 2025. We included observational studies reporting LC in adult HTX recipients and comparing survivors with non-survivors. Lactate clearance was analyzed as a dynamic marker reflecting changes in lactate levels over time. Pooled mean differences were estimated using random-effects models. Results Three observational studies, comprising 316 patients, met inclusion criteria. Mortality endpoints varied across studies and included in-hospital and short-term (30-day) mortality. Lactate clearance at 6 hours after HTX did not differ between survivors and non-survivors. At 24 hours, survivors demonstrated higher LC compared with non-survivors. Conclusions In patients undergoing HTX, impaired LC at 24 hours was associated with mortality, whereas early lactate clearance was not. Given the small number of studies, heterogeneity in outcome definitions, and observational design, these findings should be interpreted with caution and viewed as hypothesis-generating.
Summary
Keywords
Heart Failure, heart transplant (HTx), Hyperlactaemia, Lactate clearance, meta analyses
Received
15 October 2025
Accepted
12 February 2026
Copyright
© 2026 Romeo, Khan, Castillo Córdoba, Devaraju, Barbagelata, Lorente-Ros, Aguilar-Gallardo and Masson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Francisco José Romeo
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