ISHLT Primary Graft Dysfunction Incidence, Risk Factors, and Outcome: A UK National Study

Abstract

The incidence of ISHLT PGD was 36%. Thirty-day all-cause mortality in those with and without PGD was 31(19%) vs 13(4.5%) (p=0.0001). Donor, recipient and operative factors associated with PGD were: recipient diabetes mellitus (p=0.031), recipient preoperative BIVAD(p<0.001) and preoperative ECMO (p=0.023), female donor to male recipient gender mismatch(p=0.007) older donor age (p=0.010) and intracerebral haemorrhage/thrombosis in donor (p=0.023). Intra-operatively, 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 VAD/ECMO support (p=0.012), CONCLUSION: This is the first national study to examine the incidence and significance of PGD after heart transplantation using the ISHLT definition. PGD remains a frequent early complication of heart transplantation and is associated with increased mortality.

Noteworthy Literature From 2019 for Cardiothoracic Critical Care

“…Subgroup logistic regression analysis revealed implant time, gender mismatch (female donor to male recipient), and recipient resternotomy to be independent risk factors. 29 The finding of recipient pretransplant VAD as a risk factor for PGD was also identified in other recent studies. 23,30 In 2017, more than 50% of heart transplant recipients were bridged to transplant with MCS compared with 19.1% just 7 years prior.…”

“…The first national study of the incidence and associated risk factors of PGD using the current ISHLT definition was published in Transplantation in February 2019. 29 It included all first-time adult heart transplants from donors after brain death between October 2012 and October 2015 in the United Kingdom, a cohort of 450 patients. The incidence of PGD was 36.2% with 30-day and 6-month mortality rates significantly higher in patients with PGD (19% vs 4.5%, P < .001; and 31.9% vs 6.3%, P < .001, respectively).…”

“…Use of scheduled IV acetaminophen combined with propofol or dexmedetomidine leads to lower rate of delirium in elderly patients after on-pump CABG or CABG/ valve surgery, compared with placebo. Primary graft dysfunction (PGD) after heart transplant Singh et al 29 The incidence of PGD is about 36% after first-time adult heart transplant and is associated with higher mortality. Risk factors include age, implant time, gender mismatch, previous sternotomy, preoperative VAD, or ECMO.…”

Successful heart‐kidney transplantation from a Hepatitis C viremic donor to negative recipient: One year of follow‐up

“…Our case is also unique in the acuity of our patient's illness severity. The development of biventricular PGD requiring ECMO and delayed renal allograft function are attributive mortality risk factors . These factors could have significantly impacted our patient's outcome and mortality unrelated to infection with HCV from the donor organ and still could distort the interpretation of long‐term outcomes for the patient (ie, does a future event relate to his initial PGD or HCV).…”

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

“…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.…”