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ISHLT Primary Graft Dysfunction Incidence, Risk Factors, and Outcome: A UK National Study
Sanjeet Singh Avtaar Singh1,2, Nicholas R Banner3, Sally Rushton4
1Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom.
Insights
Primary graft dysfunction (PGD) affects 36% of heart transplant recipients and is linked to significantly higher mortality rates. Key risk factors include donor age, longer implant times, and recipient diabetes.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Immunology
Background:
- Heart transplantation (HTx) is the optimal treatment for end-stage heart failure.
- Primary graft dysfunction (PGD) is a critical early complication following HTx.
- The International Society for Heart and Lung Transplantation (ISHLT) established PGD diagnostic criteria in 2014.
Purpose of the Study:
- To determine the incidence of PGD in the United Kingdom.
- To identify risk factors associated with PGD.
- To assess the impact of PGD on early mortality after HTx.
Main Methods:
- Retrospective analysis of adult HTx patients from October 2012 to October 2015 across 6 UK centers.
- Comparison of donor, recipient, and operative characteristics between PGD and non-PGD groups using ISHLT criteria.
- Multivariable logistic regression analysis to identify independent risk factors for PGD.
Main Results:
- The incidence of ISHLT-defined PGD was 36%, with a 30-day mortality of 19% in the PGD group versus 4.5% in the non-PGD group.
- Significant risk factors for PGD included recipient diabetes mellitus, preoperative ventricular assist device or extracorporeal membranous oxygenation support, female donor to male recipient sex mismatch, older donor age, and intracerebral events in the donor.
- Longer implant and bypass times, and increased perioperative blood product transfusion were associated with PGD.
Conclusions:
- This national study confirms PGD is a frequent and significant early complication after HTx.
- PGD is strongly associated with increased early mortality post-heart transplantation.
- Identifying and mitigating risk factors is crucial for improving outcomes in HTx recipients.
Background:
Heart transplantation (HTx) remains the most effective long-term treatment for advanced heart failure. Primary graft dysfunction (PGD) continues to be a potentially life-threatening early complication. In 2014, a consensus statement released by International Society for Heart and Lung Transplantation (ISHLT) established diagnostic criteria for PGD. We studied the incidence of PGD across the United Kingdom.
Methods:
We analyzed the medical records of all adult patients who underwent HTx between October 2012 and October 2015 in the 6 UK heart transplant centers Preoperative donor and recipient characteristics, intraoperative details, and posttransplant complications were compared between the PGD and non-PGD groups using the ISHLT definition. Multivariable analysis was performed using logistic regression.
Results:
The incidence of ISHLT PGD was 36%. Thirty-day all-cause mortality in those with and without PGD was 31 (19%) versus 13 (4.5%) (P = 0.0001). Donor, recipient, and operative factors associated with PGD were recipient diabetes mellitus (P = 0.031), recipient preoperative bilateral ventricular assist device (P < 0.001), and preoperative extracorporeal membranous oxygenation (P = 0.023), female donor to male recipient sex mismatch (P = 0.007), older donor age (P = 0.010), and intracerebral haemorrhage/thrombosis in donor (P = 0.023). Intraoperatively, 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 ventricular assist device/extracorporeal membranous oxygenation support (P = 0.012).
Conclusions:
This is the first national study to examine the incidence and significance of PGD after HTx using the ISHLT definition. PGD remains a frequent early complication of HTx and is associated with increased mortality.
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