Primary Graft Dysfunction in Heart Transplant Recipients-Risk Factors and Longitudinal Outcomes

Area of Science:

• Cardiology
• Transplantation Medicine
• Immunology

Background:

• Significant variability existed in defining primary graft dysfunction (PGD) before the 33rd Annual International Society for Heart and Lung Transplantation conference.
• The incidence, risk factors, and outcomes of consensus-defined PGD require further investigation.

Purpose of the Study:

• To investigate the incidence, risk factors, and outcomes of consensus-defined primary graft dysfunction (PGD) in adult cardiac transplant recipients.
• To identify predictors of PGD and high immediate postoperative inotropic requirement.

Main Methods:

• Retrospective examination of 448 adult cardiac transplant recipients from 2005 to 2017.
• Comparison of patient and procedural characteristics between PGD cases and controls.
• Multivariable logistic regression to model PGD and high-inotrope requirement; longitudinal mortality follow-up.

Main Results:

• The incidence of PGD was 16.5%. No significant differences in baseline characteristics were observed between PGD and no-PGD groups.
• Each 10-minute increase in ischemic time was associated with a 5% greater odds of PGD (OR=1.05).
• PGD was associated with significantly higher 30-day, 1-year, and 5-year mortality rates compared to no PGD (45.8% vs 21.5% at 5 years).

Conclusions:

• Consensus-defined PGD is a significant predictor of increased long-term mortality after heart transplantation.
• Prolonged ischemic time is a modifiable risk factor for PGD.
• Findings have clinical implications for patient management and resource allocation under revised organ allocation systems.