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Published on: August 2, 2024
Severe and Moderate Primary Graft Dysfunction in Adult Heart Recipients
Samuel Padovani Stefen1, Davi Freitas Tenório1, Guilherme Carvalhal Gnipper Cirillo1
1Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (InCor-HCFMUSP), São Paulo, São Paulo, Brazil.
Insights
Primary graft dysfunction (PGD) occurred in 18.7% of heart transplant recipients. Donor CPR and recipient prior heart surgery were identified as risk factors, but PGD did not impact short-term survival.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Primary graft dysfunction (PGD) is a significant complication following heart transplantation.
- Identifying risk factors and understanding the impact of PGD is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of severe and moderate PGD in adult cardiac transplant recipients.
- To identify donor and recipient risk factors associated with PGD development.
- To evaluate the impact of PGD on 30-day post-transplant outcomes.
Main Methods:
- Retrospective review of medical records for 64 adult cardiac transplantations.
- Diagnosis of moderate and severe PGD using International Society for Heart and Lung Transplantation (ISHLT) criteria.
- Statistical analysis to assess associations between risk factors and PGD.
Main Results:
- The incidence of severe or moderate PGD was 18.7% (12/64 recipients).
- PGD development was significantly associated with donor cardiopulmonary resuscitation (P=0.01) and recipient history of prior heart surgery (P=0.02).
- No significant difference in 30-day in-hospital mortality was observed between patients with and without PGD.
Conclusions:
- The ISHLT criteria are valuable for identifying PGD risk factors.
- PGD did not adversely affect short-term survival in this cohort.
- Further research is needed to elucidate the pathophysiology of PGD.
Introduction:
The aims of this study were to determine the incidence of severe and moderate primary graft dysfunction (PGD) in our center, to identify, retrospectively, donors' and recipients' risk factors for PGD development, and to evaluate the impact of PGD within 30 days after heart transplantation.
Methods:
Donors' and recipients' medical records of 64 consecutive adult cardiac transplantations performed between January 2016 and June 2017 were reviewed. The International Society for Heart and Lung Transplantation (ISHLT) criteria were used to diagnose moderate and severe PGD. Associations of risk factors for combined moderate/severe PGD were assessed with appropriate statistical analyses.
Results:
Sixty-four patients underwent heart transplantation in this period. Twelve recipients (18.7%) developed severe or moderate PGD. Development of PGD was associated with previous donor cardiopulmonary resuscitation and a history of prior heart surgery in the recipient (P=0.01 and P=0.02, respectively). The 30-day in hospital mortality was similar in both PGD and non-PGD patients.
Conclusion:
The use of the ISHLT criteria for PGD is important to identify potential risk factor. The development of PGD did not affect short-term survival in our study. More studies should be done to better understand the pathophysiology of PGD.
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