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Long-term outcomes of patients with primary graft dysfunction after cardiac transplantation
John J Squiers1,2, J Michael DiMaio2, Johanna Van Zyl3
1Baylor University Medical Center, Dallas, TX, USA.
Insights
Primary graft dysfunction (PGD) after heart transplant impacts long-term survival, but survivors of severe PGD beyond 90 days face no increased mortality risk. This finding is crucial for cardiac transplant outcomes research.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- The International Society of Heart and Lung Transplantation (ISHLT) criteria for primary graft dysfunction (PGD) effectively stratify cardiac transplant patient outcomes up to one year.
- Limited data exist on long-term survival beyond the first year for patients experiencing PGD post-cardiac transplantation.
Purpose of the Study:
- To investigate and characterize the survival rates of patients diagnosed with PGD following cardiac transplantation, specifically focusing on outcomes beyond the first year post-transplant.
- To evaluate the long-term prognostic implications of varying severities of PGD on patient survival after heart transplantation.
Main Methods:
- A retrospective analysis of 257 consecutive patients undergoing isolated cardiac transplantation between 2012 and 2015 at a single center.
- Patients were classified based on ISHLT criteria into none, mild, moderate, or severe PGD groups. Survival data were collected from the United Network for Organ Sharing database and chart reviews.
- Kaplan-Meier curves and Cox-proportional hazards modeling, including a conditional survival analysis at 90 days, were used to assess mortality risk associated with PGD severity.
Main Results:
- Out of 257 patients, 73 (28%) had PGD: 43 mild (17%), 12 moderate (5%), and 18 severe (7%).
- Patients with moderate or severe PGD exhibited significantly decreased survival up to 5 years post-transplantation (log-rank P < 0.001).
- Landmark analysis revealed a substantially increased mortality risk for moderate/severe PGD within the first 90 days (HR 18.9, P < 0.001), which did not persist in survivors beyond 90 days (P = 0.64).
Conclusions:
- Moderate or severe PGD following cardiac transplantation is linked to elevated mortality risk extending up to 5 years post-transplant.
- Crucially, cardiac transplant recipients with moderate or severe PGD who survive the initial 90 days post-transplantation do not face a continued increased risk of mortality compared to those with no or mild PGD.
Objectives:
The International Society of Heart and Lung Transplantation (ISHLT) criteria for primary graft dysfunction (PGD) after cardiac transplantation have been shown to stratify patient outcomes up to 1 year after transplantation, but scarce data are available regarding outcomes beyond the 1st year. We sought to characterize survival of patients with PGD following cardiac transplantation beyond the 1st year.
Methods:
A retrospective review of consecutive patients undergoing isolated cardiac transplantation at a single centre between 2012 and 2015 was performed. Patients were diagnosed with none, mild, moderate or severe PGD by the ISHLT criteria. Survival was ascertained from the United Network for Organ Sharing database and chart review. Kaplan-Meier curves were plotted to compare survival. The hazard ratio for mortality associated with PGD severity was estimated using Cox-proportional hazards modelling, with a pre-specified conditional survival analysis at 90 days.
Results:
A total of 257 consecutive patients underwent cardiac transplantation during the study period, of whom 73 (28%) met ISHLT criteria for PGD: 43 (17%) mild, 12 (5%) moderate and 18 (7%) severe. Patients with moderate or severe PGD had decreased survival up to 5 years after transplantation (log-rank P < 0.001). Landmark analyses demonstrated that patients with moderate or severe PGD were at increased risk of mortality during the first 90-days after transplantation as compared to those with none or mild PGD [hazard ratio (95% confidence interval) 18.9 (7.1-50.5); P < 0.001], but this hazard did not persist beyond 90-days in survivors (P = 0.64).
Conclusions:
A diagnosis of moderate or severe PGD is associated with increased mortality up to 5 years after cardiac transplantation. However, patients with moderate or severe PGD who survive to post-transplantation day 90 are no longer at increased risk for mortality as compared to those with none or mild PGD.
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