Report from a consensus conference on primary graft dysfunction after cardiac transplantation

Kobashigawa, Jon A.; Zuckermann, Andreas; Macdonald, Peter S.; Leprince, Pascal; Esmailian, F.; Luu, Minh B.; Mancini, Donna; Patel, Jignesh; Razi, Rabia R.; Reichenspurner, Hermann; Russell, Stuart; Segovia, Javier; Smedira, Nicholas; Stehlik, Josef; Wagner, Florian

doi:10.1016/j.healun.2014.02.027

Cited by 589 publications

(551 citation statements)

References 59 publications

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“…A recent consensus document reviewed epidemiology, pathogenesis, risk factors, biomarkers and management, and arrived at definitions of PGD. 5 Nonetheless, the incidence of and risk factors for PGD remain poorly understood. In this report we explored EGF, defined as a composite end-point of death or retransplant associated with graft failure within the first 30 days after transplant.…”

Section: Figure 21mentioning

confidence: 99%

The Registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Heart Transplantation Report—2015; Focus Theme: Early Graft Failure

Lund¹,

Edwards²,

Kucheryavaya³

et al. 2015

The Journal of Heart and Lung Transplantation

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480

292

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Section: Figure 21mentioning

confidence: 99%

The Registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Heart Transplantation Report—2015; Focus Theme: Early Graft Failure

Lund¹,

Edwards²,

Kucheryavaya³

et al. 2015

The Journal of Heart and Lung Transplantation

Self Cite

480

292

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“…Donor age, organ ischemic time, mechanical circulatory support [including right ventricular assist devices (RVADs)] prior to transplant, and congenital etiology in the recipient seem to be associated with a higher rate of PGD. Recently, a consensus statement, which attempted to better define PGD in heart transplantation, classified severe PGD as a need for mechanical circulatory support (other than an intra-aortic balloon pump) to maintain adequate endorgan perfusion following the procedure (18). Mechanical circulatory support can be provided by VA-ECMO or implantation of a temporary VAD.…”

Section: Ecls After Heart Transplantmentioning

confidence: 99%

Extracorporeal life support in preoperative and postoperative heart transplant management

Bermúdez

McMullan

2017

Annals of Translational Medicine

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Increased experience with extracorporeal life support (ECLS) as a mode of cardiac support has expanded its use to diverse patient populations including patients requiring a bridge to heart transplantation and patients requiring posttransplant support for primary graft dysfunction (PGD). The use of ECLS is associated with acceptable outcomes in well-selected patients. While outcomes with the use of extracorporeal membrane oxygenation (ECMO) as a bridge to heart transplant have been variable, several series have confirmed the safe use of ECLS to stabilize patients prior to left ventricular assist device (LVAD) implantation. These patients are then considered later, when in stable condition, for heart transplant.When ECLS is used prior to heart transplant, mortality is greatest during the first 6 months posttransplant.Patients who are alive 6 months after transplant appear to have similar survival rates as patients who were not supported with ECLS prior to transplant. ECLS support is a reliable therapeutic option for severe PGD and early graft failure after heart transplantation. In patients who require support for severe PGD, venoarterial-ECMO appears to result in better clinical outcomes than LVAD support. ECLS use for PGD after heart transplant continues to be the first line of support. Further studies are necessary to understand the optimal role of ECLS in heart transplantation.

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“…In addition, some highvolume centers prefer intra-aortic balloon pump as a first-line mechanical support. 11 We preferred VA-ECMO as a mechanical support in cases of PGD according to our center's protocol.…”

Section: Ender Gedik Et Al/experimental and Clinical Transplantation mentioning

confidence: 99%

“…6 The use of VA-ECMO during both the early and late postoperative periods for severe PGD in heart transplant recipients is a widely accepted multidisciplinary treatment. 5,11 However, we used postoperative extracorporeal support in our patients. We have limited experience regarding VA-ECMO support for PGD in heart transplant recipients.…”

Section: Ender Gedik Et Al/experimental and Clinical Transplantation mentioning

confidence: 99%

Untitled

Gedik

Atar²,

Özdemirkan³

et al. 2017

Exp Clin Transplant

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Objectives: Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. This technique may be used after heart transplant for conditions refractory to medical treatment like primary graft failure. Previously, we reported our experience with patients who received extracorporeal support as a bridge to emergency heart transplant. In this study, we present our perioperative experience with heart transplants in which extracorporeal support was used. Materials and Methods:We retrospectively screened the data of 31 patients who were seen at our center between January 2014 and June 2016. We screened for patients who were admitted to the intensive care unit before transplant and who required venoarterial extracorporeal membrane oxygenation for circulatory support and postoperative patients who required extracorporeal support. Patient demographics and characteristics, clinical data, and extracorporeal support data were collected from our electronic database and patient medical records. Results: There were 14 patients who required perioperative extracorporeal support. Preoperative support was performed in 3 patients before transplant, and postoperative support was performed in 11 patients after transplant. The mean age was 37.7 years in patients within the preoperative group and 29.7 years in patients within the postoperative group. One patient with preoperative support and 5 with postoperative support were pediatric patients. The main indication for transplant was dilated cardiomyopathy in both groups (100% and 63.7%). Overall mortality rates were 33% in the preoperative group and 63.7% in the postoperative group. Conclusions: For patients on heart transplant wait lists who are worsening despite optimal medical therapy, venoarterial extracorporeal membrane oxygenation support is a safe and viable last resort. In addition, extracorporeal support can be used during the posttransplant period as salvage therapy in heart recipients with hemodynamic deterioration. In our experience, preoperative extracorporeal support had lower mortality rates compared with postoperative support.

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Report from a consensus conference on primary graft dysfunction after cardiac transplantation

Cited by 589 publications

References 59 publications

The Registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Heart Transplantation Report—2015; Focus Theme: Early Graft Failure

The Registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Heart Transplantation Report—2015; Focus Theme: Early Graft Failure

Extracorporeal life support in preoperative and postoperative heart transplant management

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