Donor predicted heart mass as predictor of primary graft dysfunction

Gong, Timothy; Joseph, Susan; Lima, Brian; González-Stawinski, Gonzalo V.; Jamil, Aayla K.; Felius, Joost; Qin, Haili; Saracino, Giovanna; Rafael, Aldo; Kale, Parag; Hall, Shelley

doi:10.1016/j.healun.2018.03.009

Cited by 56 publications

(27 citation statements)

References 33 publications

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“…In support of this, donor-recipient PHM undersizing was associated with primary graft dysfunction in a recent study, whereas weight was not. 13 Our study supports this finding, because we observed that recipients severely undersized for PHM experienced increased mortality early after HTX.…”

Section: Discussionsupporting

confidence: 87%

“…11,12 Recently, PHM, but not body weight, predicted the development of primary graft dysfunction after HTX. 13 Given uncertainty regarding the optimal metric of donor-recipient size match, we compared the ability of PHM to 4 other size match metrics-weight, height, BMI, and body surface area (BSA)-to predict 1-year mortality after HTX. We also identified the effect of donor-recipient size match on donor heart turn down for size during allocation.…”

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confidence: 99%

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Predicted heart mass is the optimal metric for size match in heart transplantation

Kransdorf

Kittleson

Benck

et al. 2019

The Journal of Heart and Lung Transplantation

158

133

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Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 99%

Predicted heart mass is the optimal metric for size match in heart transplantation

Kransdorf

Kittleson

Benck

et al. 2019

The Journal of Heart and Lung Transplantation

158

133

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“…The lack of association suggests that different inflammatory and immune pathways lead to PGD and ACR after lung and heart transplantation. The incidence of PGD in this study is similar to previous reports . According to the ISHLT Registry, 27.3% of lung transplant recipients were treated for at least 1 episode of ACR in the 1st year post‐transplant .…”

Section: Discussionsupporting

confidence: 89%

“…Similarly, the ISHLT developed a definition for PGD after lung transplantation in 2005 and subsequently refined the criteria in 2016 . The standardization of PGD definitions has provided a more consistent approach for scoring PGD and created a platform to evaluate potential risk factors . The pathogenesis of PGD represents both inflammatory and ischemia‐reperfusion–related mechanisms …”

Section: Introductionmentioning

confidence: 99%

Comparison of outcomes in lung and heart transplant recipients from the same multiorgan donor

Takahashi

Terada

Pasque

et al. 2019

Clinical Transplantation

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Primary graft dysfunction (PGD) is a clinical manifestation of ischemic-reperfusion injury (IRI) and the most important cause of early morbidity and mortality after lung and heart transplantation. 1,2 Furthermore, in spite of advances in immunosuppression, acute cellular rejection (ACR) remains a common complication after lung and heart transplantation. 3,4 The International Society for Heart and Lung Transplantation (ISHLT) created a standardized definition and grading system for PGD after heart transplantation in 2014. 2 Similarly, the ISHLT developed a definition for PGD after lung transplantation in 2005 and subsequently refined the criteria in 2016. 5,6 The standardization of PGD definitions has provided a more consistent approach for scoring PGD and created a platform to evaluate potential risk factors. 7,8 The pathogenesis of PGD represents both inflammatory and ischemia-reperfusion-related mechanisms. 9 Although new mechanistic insights of ACR have been recently reported, especially after lung transplantation, 10 there has been little work examining the influence of donor factors. Brain death is associated with systemic inflammatory responses characterized by the release of proinflammatory cytokines, such as interleukin-6 and tumor necrosis factor-alpha, which could lead to allograft injury. 11 Abstract Background: Primary graft dysfunction (PGD) and acute cellular rejection (ACR) are important causes of early morbidity and mortality following lung and heart transplantation. While many studies have elucidated donor-related risk factors of PGD and ACR, these complications often occur even with "ideal" donors. Therefore, we investigated potential associations of PGD and ACR between bilateral lung and heart transplant recipients from the same multiorgan donor, respectively. Methods: Between 2011 and 2017, 100 donors contributed 100 bilateral lung transplants and 100 heart transplants performed. Logistic regression analysis for PGD and Cox proportional hazards regression analysis for ACR were used to estimate the relationship of heart and lung transplants.Results: The incidence of PGD was 33% among lung and 17% among heart transplant recipients. Similarly, the incidence of ACR grade ≥ A2 for lung recipients was 38% (30/80), and the incidence of ACR grade ≥ 2R for heart recipients was 19% (15/80).There was no association between the development of PGD and ACR in lung and heart transplant recipients from the same donor, respectively.Conclusions: These findings suggest that inherent donor factors are not critical to the development of PGD and ACR after lung and heart transplantation. K E Y W O R D Sacute, donation after brain death (DBD), donors and donation, organ procurement, rejection

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“…After the recent introduction of the ISHLT consensus conference definition of PGF, contemporary data suggest an overall incidence of 10% to 36%, with severe PGF—likely the most clinically relevant entity—occurring in 8% to 18% of HT recipients (Table ) . Similar to difficulties in reporting the incidence of PGF due to non‐universal definitions, reported risk factors have also varied substantially by era, transplant center, and patient population.…”

Section: Preoperative Risksmentioning

confidence: 99%

Management of primary graft failure after heart transplantation: Preoperative risks, perioperative events, and postoperative decisions

Truby

DeRoo

Spellman

et al. 2019

Clinical Transplantation

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Primary graft failure (PGF) after heart transplantation (HT) is a devastating and unexpected event characterized by failure of the graft to adequately support recipient circulation necessitating high doses of vasopressors and inotropes and/or temporary mechanical circulatory support. Although it represents an increasingly common event in the current era, there remains a high degree of variability in prevalence, reported risk factors, and approach to this clinical entity. The purpose of the current review is to highlight preoperative considerations including known incidence and risk factors, perioperative issues involving the identification and management of PGF, and postoperative decisions related to weaning of mechanical circulatory support and titration of immunosuppressive therapy. Lastly, we highlight future directions in PGF research, involving basic and translational research, that have the potential to uncover novel strategies of risk stratification and treatment.Case: Our patient is a 53-year-old man with end-stage non-ischemic dilated cardiomyopathy complicated by ventricular tachycardia (VT), post-capillary pulmonary hypertension, and renal insufficiency. After progressing to NYHA Class IV symptoms, he underwent implantation of a durable left ventricular assist device (LVAD) as bridge to transplant (BTT). On device support, he developed recurrent VT resulting in multiple defibrillator discharges and hospital admission for intravenous anti-arrhythmic therapy. He is subsequently upgraded to a higher status on the waiting list. A suitable donor is identified, with an appropriate predicted heart mass and an anticipated ischemic time of <4 hours. He is taken to the operating room, where at the time of anesthesia induction he develops vasodilatory shock, requiring high-dose vasopressors, and cardiopulmonary bypass (CPB) support for dissection. After surgical anastomosis, cross clamp removal and reperfusion, graft function is extremely poor, there is significant bradycardia requiring pacing, and the patient is unable to be weaned successfully from CPB. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is initiated, and the patient is transferred to the intensive care unit. Retrospective flow crossmatch is negative. This patient is suffering from severe primary graft failure. K E Y W O R D Sgraft survival, heart (allograft) function/dysfunction, heart failure/injury

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Donor predicted heart mass as predictor of primary graft dysfunction

Abstract: Undersized donor hearts by ≥30% by PHM may increase rates of PGD after transplantation, confirming that PHM provides more clinically appropriate size matching than TBW. Better size matching may ultimately allow for expanding the donor pool.

Cited by 56 publications

References 33 publications

Predicted heart mass is the optimal metric for size match in heart transplantation

Predicted heart mass is the optimal metric for size match in heart transplantation

Comparison of outcomes in lung and heart transplant recipients from the same multiorgan donor

Management of primary graft failure after heart transplantation: Preoperative risks, perioperative events, and postoperative decisions

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