ISHLT Primary Graft Dysfunction Incidence, Risk Factors, and Outcome: A UK National Study. Issue 2 (February 2019)

• Record Type: Journal Article
• Authors: Avtaar Singh, Sanjeet Singh; Banner, Nicholas R.; Rushton, Sally; Simon, Andre R.; Berry, Colin; Al-Attar, Nawwar
• Is Part Of: Transplantation. Volume 103:Issue 2(2019)
• Publication Date: 2019-02
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000002220
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: Heart transplantation (HTx) remains the most effective long-term treatment for advanced heart failure. Primary graft dysfunction (PGD) continues to be a potentially life-threatening early complication. In 2014, a consensus statement released by International Society for Heart and Lung Transplantation (ISHLT) established diagnostic criteria for PGD. We studied the incidence of PGD across the United Kingdom. Methods: We analyzed the medical records of all adult patients who underwent HTx between October 2012 and October 2015 in the 6 UK heart transplant centers Preoperative donor and recipient characteristics, intraoperative details, and posttransplant complications were compared between the PGD and non-PGD groups using the ISHLT definition. Multivariable analysis was performed using logistic regression. Results: The incidence of ISHLT PGD was 36%. Thirty-day all-cause mortality in those with and without PGD was 31 (19%) versus 13 (4.5%) ( P = 0.0001). Donor, recipient, and operative factors associated with PGD were recipient diabetes mellitus ( P = 0.031), recipient preoperative bilateral ventricular assist device ( P < 0.001), and preoperative extracorporeal membranous oxygenation ( P = 0.023), female donor to male recipient sex mismatch ( P = 0.007), older donor age ( P = 0.010), and intracerebral haemorrhage/thrombosis in donor ( P = 0.023). Intraoperatively, implant time ( P = 0.017) and bypass time ( P < 0.001) were significantly longer in the PGD cohort. Perioperatively, patients with PGD received more blood products ( P < 0.001). Risk factors identified by multivariable logistic regression were donor age ( P = 0.014), implant time ( P = 0.038), female: male mismatch ( P = 0.033), recipient diabetes ( P = 0.051) and preoperative ventricular assist device/extracorporeal membranous oxygenation support ( P = 0.012). Conclusions: This is the first national study to examine the incidence and significance of PGD after HTx using the ISHLT definition. PGD remains a frequent early complication of HTx and is associated with increased mortality. Abstract : The incidence and significance of primary graft dysfunction (PGD) after heart transplantation are examined in the 6 UK heart transplant centers using the ISHLT definition and PGD remains a frequent early complication of heart transplantation and is associated with increased mortality.