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Updated: Jul 22, 2026
Murine Heterotopic Heart Transplant Technique
Published on: July 8, 2014
Necropsy findings in heart transplant recipients with or without primary graft dysfunction
Deborah S P Belfort1, Sandrigo Mangini1, Mônica S Ávila1
1Heart Transplant Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Insights
Primary graft dysfunction (PGD) after heart transplant (HT) is a major concern. This study found similar cardiac pathology, including frequent necrosis, in patients with and without PGD who died within 14 days post-transplant.
Area of Science:
- Cardiology
- Transplant Surgery
- Pathology
Background:
- Primary graft dysfunction (PGD) is a significant cause of mortality following heart transplantation (HT).
- The precise pathophysiology and histological characteristics of PGD remain incompletely understood.
- This study aimed to elucidate morphological differences in cardiac tissue between patients with and without PGD.
Purpose of the Study:
- To compare the histological and morphological findings in the hearts of heart transplant recipients who developed primary graft dysfunction versus those who did not.
- To investigate the role of myocardial necrosis in the context of PGD and early post-transplant mortality.
Main Methods:
- Retrospective analysis of clinical and histological data from adult heart transplant recipients who died within 14 days post-transplant.
- Inclusion of 26 patients from a single center, categorized into PGD (n=11) and non-PGD (n=15) groups.
- Blinded pathological review of cardiac slides to assess morphological findings, including types and extent of necrosis.
Main Results:
- No significant differences in necropsy findings were observed between the PGD and non-PGD groups.
- Myocardial necrosis was prevalent in 80.7% of all cases, affecting a substantial portion of the myocardial area in nearly half of the patients.
- While the PGD group showed trends towards longer ischemic times and higher use of mechanical support, histological findings were comparable.
Conclusions:
- Cardiac pathological findings, including the presence and type of necrosis, were similar in heart transplant recipients with and without PGD who died early post-transplant.
- The frequent occurrence of necrosis in both groups suggests it may not be the primary driver of cardiac dysfunction in PGD.
- Further research is warranted to understand the underlying mechanisms of PGD beyond myocardial necrosis.
Background:
Primary graft dysfunction (PGD) is the leading cause of death in the first year after heart transplant (HT), but pathophysiology and histology are not completely understood. This study describes and compares morphological findings of hearts of patients with and without PGD.
Methods:
We included adult patients submitted to HT in a single center who died within the first 14 days after HT and were submitted to necropsy. Clinical and histological data were recorded retrospectively. All heart slides were reviewed by a blinded pathologist. We categorized patients in two groups (PGD and non-PGD) and compared findings between them.
Results:
Among 322 HTs, 26 patients were included. Median age was 51.5 years, 57.7% were male, 46.1% had non-ischemic cardiomyopathy, 30.8% Chagas cardiomyopathy and 23% ischemic cardiomyopathy. Eleven patients presented PGD, while 15 patients did not. PGD was severe in 72.7% of cases and moderate in 27.3%. PGD group had longer ischemic time (p=0.08), higher incidence of mechanical circulatory support (p=0.004), lower post-transplant biventricular ejection fraction (p=0.005). However, necropsy findings were similar between groups. Necrosis was detected in 80.7% of all cases (p=0.907 comparing groups), taking ≥ 10% of myocardial area in 46.1% of them, and 4 types of necrosis were found either in patients with and without PGD.
Conclusion:
Cardiac pathological findings were similar in HT patients with or without PGD who died within 14 days after the transplant and necrosis was frequent in both groups, raising the hypothesis necrosis is not the cause of cardiac dysfunction in PGD.
