Application of the International Society for Heart and Lung Transplantation (ISHLT) criteria for primary graft dysfunction after cardiac transplantation: outcomes from a high-volume centre

Squiers, John J.; Saracino, Giovanna; Chamogeorgakis, Themistokles; MacHannaford, Juan C.; Rafael, Aldo; González-Stawinski, Gonzalo V.; Hall, Shelley; DiMaio, J. Michael; Lima, Brian

doi:10.1093/ejcts/ezw271

Cited by 33 publications

(52 citation statements)

References 19 publications

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“…With application of the adult ISHLT criteria for moderate and severe PGD after pediatric cardiac transplantation, moderate/severe PGD occurred frequently in children in the current era (16.3%). This incidence is similar to that reported by studies after application of these guidelines in adults, with PGD ranging from 9%‐32% . A previous assessment of PGD from our institution in an earlier era (1986‐2001), similarly defined by need for MCS or high‐dose inotropes, to be 32.7% overall.…”

Section: Discussionsupporting

confidence: 87%

“…In 2014, ISHLT consensus guidelines were published defining standardized criteria for PGD, as well as allowing for classification of severity . Since this publication, several adult centers have validated these criteria, primarily in single‐center series, with prevalence ranging from 9%‐32% . They also have demonstrated increased mortality in patients with moderate as well as severe PGD.…”

Section: Introductionmentioning

confidence: 99%

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Moderate‐severe primary graft dysfunction after pediatric heart transplantation

Mowers

Simpson

Gazit

et al. 2019

Pediatric Transplantation

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Background PGD is a complication after heart transplantation (OHT) and a significant cause of mortality, particularly in infant recipients. Lack of standardized definition of PGD in the pediatric population makes the prevalence and magnitude of impact unclear. Methods ISHLT PGD consensus guidelines, which include inotrope scores and need for MCS, were applied retrospectively to 208 pediatric OHT recipients from a single institution from 1/2005‐5/2016. PGD was defined as: moderate PGD—inotrope score >10 on postoperative day 1 (24‐48 hours), and severe PGD—MCS within 24 hours (in the absence of detectable rejection). Results PGD occurred in 34 patients (16.3%); 14 of which had severe PGD (6.7%). Multivariate risk factors for PGD included CPB time (OR 10.3/10 min, 95% 10.05, 10.2, P = 0.03), Fontan palliation (OR 1.9, 95% 1.2, 3.97), and PCM (OR 5.65, 95% 1.52, 22.4); but not age, weight, ischemic time, or donor characteristics. Upon sub‐analysis excluding patients with PCM, increased CPB was a significant multivariate risk factor (OR 10.09, 95% 9.89, 10.12, P = 0.003). Patients with PGD had decreased discharge survival compared to those without PGD (85% vs 96%, P < 0.01). Severe PGD was associated with the poorest 1‐year survival (57% vs 91% without PGD, P = 0.04). Conclusion Patients with prolonged CPB are potentially at risk for developing PGD. Neither infant recipients nor donor characteristics were associated with an increased risk of PGD in the current era.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Moderate‐severe primary graft dysfunction after pediatric heart transplantation

Mowers

Simpson

Gazit

et al. 2019

Pediatric Transplantation

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“…Per protocol, donor heart catheterizations were requested for all donors over age 40 and diabetic donors over age 30, and we routinely performed primary virtual cross‐matching for sensitized recipients. The same transplantation protocol was implemented throughout the study period, as previously described . At our center, a heart team approach is utilized when considering offers of donor hearts.…”

Section: Methodsmentioning

confidence: 99%

“…Recipient outcomes, including mortality, primary graft dysfunction, and graft rejection, were assessed. Primary graft dysfunction (PGD) was diagnosed and classified according to the 2014 International Society of Heart and Lung Transplantation (ISHLT) criteria . Fisher's exact tests for categorical measures and the non‐parametric Wilcoxon (Mann‐Whitney) rank‐sum tests for continuous measures were performed for comparison of the study cohorts.…”

Section: Methodsmentioning

confidence: 99%

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Utilization of high donor sequence number grafts in cardiac transplantation

Squiers

DiMaio

Saracino

et al. 2017

Clinical Transplantation

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Donor sequence number (DSN) represents the number of candidates to whom a graft was offered and declined prior to acceptance for transplantation. We sought to investigate the outcomes of patients receiving high DSN grafts. Consecutive isolated adult cardiac transplantations performed at a single-center were reviewed. Recipients were grouped into standard (≤75th percentile) DSN and high (>75th percentile) DSN. A previously validated donor risk index was used to quantify the risk associated with donor grafts, and recipient outcomes were assessed. Overall, 254 patients were included: 194 standard DSN (range 1-79) and 60 high DSN (range 82-1723). High DSN grafts were harvested at greater distance (P < .001) with increased ischemia time (P < .001), resulting in a modest increase in donor risk index (1 point median difference, P = .014). High DSN recipients were less frequently listed as UNOS status 1A (P < .001). Despite a nonsignificant trend toward increased in-hospital/30-day mortality in high DSN recipients, there were no differences in primary graft dysfunction or 1-year survival (high DSN 89% vs standard DSN 88%, P = .82). After adjustment for risk factors, high DSN was not associated with increased 1-year mortality (hazard ratio 1.18, 95%-CI 0.54-2.58, P = .68).

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Primary graft dysfunction after heart transplantation: a thorn amongst the roses

et al. 2019

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Primary graft dysfunction (PGD) remains the leading cause of early mortality post-heart transplantation. Despite improvements in mechanical circulatory support and critical care measures, the rate of PGD remains significant. A recent consensus statement by the International Society of Heart and Lung Transplantation (ISHLT) has formulated a definition for PGD. Five years on, we look at current concepts and future directions of PGD in the current era of transplantation.

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Application of the International Society for Heart and Lung Transplantation (ISHLT) criteria for primary graft dysfunction after cardiac transplantation: outcomes from a high-volume centre

Abstract: A diagnosis of PGD portends worse outcomes including increased 30-day and 1-year mortality. The ISHLT diagnostic criteria for moderate and severe PGD identify and discriminate patients with PGD in a clinically relevant manner.

Cited by 33 publications

References 19 publications

Moderate‐severe primary graft dysfunction after pediatric heart transplantation

Moderate‐severe primary graft dysfunction after pediatric heart transplantation

Utilization of high donor sequence number grafts in cardiac transplantation

Primary graft dysfunction after heart transplantation: a thorn amongst the roses

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