Primary Graft Failure after Heart Transplantation

Abstract

Primary graft failure (PGF) is a devastating complication that occurs in the immediate postoperative period following heart transplantation. It manifests as severe ventricular dysfunction of the donor graft and carries significant mortality and morbidity. In the last decade, advances in pharmacological treatment and mechanical circulatory support have improved the outlook for heart transplant recipients who develop this complication. Despite these advances in treatment, PGF is still the leading cause of death in the first 30 days after transplantation. In today's climate of significant organ shortages and growing waiting lists, transplant units worldwide have increasingly utilised “marginal donors” to try and bridge the gap between “supply and demand.” One of the costs of this strategy has been an increased incidence of PGF. As the threat of PGF increases, the challenges of predicting and preventing its occurrence, as well as the identification of more effective treatment modalities, are vital areas of active research and development.

Early Outcomes With Marginal Donor Hearts Compared With Left Ventricular Assist Device Support in Patients With Advanced Heart Failure

“…Conversely, there is evidence of increased rates of primary graft failure and mortality in heart transplant recipients of marginal donor organs [17]. This is supported by our study findings that survival is worse in recipients of marginal donor organs when compared with optimal donor organs.…”

Impact of basal heart rate on long-term prognosis of heart transplant patients

“…This factor needs to be taken into account as PGF is per se a factor that has proven to reduce survival in HTx recipients. However, PGF has been associated with an increased early mortality in the immediate post-transplant period [23]. We therefore believe that the impact of this factor is not significant in long-term survival, since we took as the starting point for the study at 1 year after HTx.…”

Primary Graft Dysfunction After Heart Transplantation

“…Although a high RADIAL risk score was clearly associated with increased risk of PGD, a major constraint, as noted by the authors, was the limited predictive power when applied to individual patients (as opposed to group data), as exemplified by the fact that most patients in the high-risk group did not develop PGD. Another potential limitation was the low use of VAD support in both [12] the derivation and validation studies, raising a question regarding the applicability of the RADIAL score in VADsupported transplant recipients. Regardless of these limitations, however, the RADIAL risk score provides an excellent example of the cumulative risk of PGD in the presence of combined donor, procedural, and recipient risk factors.…”