Regional differences in primary graft dysfunction: A report from the international consortium on PGD

The impact of regional differences on primary graft dysfunction (PGD) after heart transplantation (HT) has not been assessed. This study aims to compare differences in the incidence, risk factors, and outcomes of severe PGD in the US, Canada, and Europe.

This retrospective, observational study included consecutive adult HT recipients from 14 centers between 2010-2022. The primary outcome was severe PGD as defined by ISHLT criteria. Multivariable logistic regression analyses were conducted. Survival data were analyzed using a proportional hazards Cox model.

4101 HT recipients were included in the analysis (2077 US, 730 Canada, 1294 Europe). Significant differences were observed in recipient cardiovascular risk factors, pre-HT mechanical circulatory support (MCS), ischemic time, and donor age. Severe PGD occurred in 8.6%, 9.0%, and 9.6% of HTs in the US, Canada, and Europe. There was an increasing trend in severe PGD incidence in the US and Canada over time. Risk factors for severe PGD were similar across regions and included pre-HT dialysis, durable LVAD or pre-HT MCS, and ischemic time. VA-ECMO was the preferred MCS strategy for PGD management in all three regions. Thirty-day (8.9%, 29.8%, 43.9%) and 1-year (26.3%, 50.8%, 48.5%) mortality after severe PGD in the US was significantly lower than in Canada and Europe.

The incidence of severe PGD is similar across the US, Canada, and Europe, but with a lower mortality after severe PGD in the US. Analyzing regional differences in PGD can aid in development of best practices for survival after this devastating event.