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Clinical Factors Implicated in Primary Graft Dysfunction After Heart Transplantation: A Single-center Experience
R A Quintana-Quezada1, I Rajapreyar1, A Postalian-Yrausquin1
1Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas.
Insights
A longer interval between brain death and aortic cross-clamp in heart transplantation is linked to reduced primary graft dysfunction (PGD). This finding suggests delaying organ procurement may prevent PGD, a major cause of mortality.
Area of Science:
- Cardiology
- Transplantation Immunology
- Surgical Outcomes
Background:
- Primary graft dysfunction (PGD) is a significant complication following cardiac transplantation.
- PGD is a leading cause of mortality in heart transplant recipients.
- Identifying factors associated with PGD is crucial for developing preventive strategies.
Purpose of the Study:
- To identify donor and surgical factors associated with PGD after cardiac transplantation.
- To guide strategies for PGD prevention.
Main Methods:
- Retrospective analysis of medical records of cardiac transplant recipients.
- Study period: October 2012 to February 2015.
- Inclusion of 99 patients, with 18 developing PGD.
Main Results:
- Univariate analysis identified donor opioid use and death due to anoxia as associated with PGD.
- Recipient/donor blood type AB/A match and longer time from brain death to aortic cross-clamp (TBDACC) ≥3 and ≥5 days were associated with PGD.
- Multivariate analysis confirmed that longer TBDACC (≥3 and ≥5 days) was associated with significantly lower odds of developing PGD (OR 0.098 and 0.092, respectively).
Conclusions:
- A longer TBDACC is associated with a reduced likelihood of PGD.
- Postponing heart procurement for a few days after brain death may be beneficial in preventing PGD.
Background:
Primary graft dysfunction (PGD) is a frequent complication after cardiac transplantation and remains one of the leading causes of mortality in these patients. The objective of this case-control study is to identify donor and surgical procedure's factors associated with PGD, and further guide possible strategies to prevent PGD.
Methods:
Retrospective analysis of the medical records of patients who underwent cardiac transplantation at Memorial Hermann Hospital at Texas Medical Center between October 2012 and February 2015.
Results:
The study population included 99 patients, of which 18 developed PGD. Univariate analysis of donor characteristics revealed opioid use (P = .049) and death owing to anoxia (P = .021) were associated with PGD. The recipient/donor blood type match AB/A was significantly associated with PGD (P = .031). Time from brain death to aortic cross clamp (TBDACC) of ≥3 and ≥5 days were also found to be associated with PGD (P = .0011 and .0003, respectively). Multivariate analysis confirmed that patients with a time from brain death to aortic cross clamp ≥3 and ≥5 days had lesser odds of developing PGD (odds ratio, 0.098 [P = .0026] and OR, 0.092 [P = .0017], respectively].
Conclusions:
Our study showed that a longer time from brain death to aortic cross clamp was associated with lower odds of developing PGD. Therefore, postponing heart procurement for a few days after brain death seems to be beneficial in preventing PGD.
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