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

Area of Science:

• Cardiology
• Transplantation Medicine
• Outcomes Research

Background:

• Regional variations in primary graft dysfunction (PGD) post-heart transplantation (HT) remain understudied.
• Assessing PGD incidence, risk factors, and outcomes across distinct geographical regions is crucial for improving patient survival.

Purpose of the Study:

• To compare the incidence, risk factors, and outcomes of severe PGD in heart transplant recipients across the United States, Canada, and Europe.
• To identify potential regional disparities in PGD management and survival.

Main Methods:

• Retrospective analysis of 4101 adult heart transplant recipients from 14 centers (2010-2022).
• Severe PGD defined by ISHLT criteria; multivariable logistic regression and Cox proportional hazards models used for analysis.
• Data stratified by region: US, Canada, and Europe.

Main Results:

• Severe PGD incidence was comparable across regions (US: 8.6%, Canada: 9.0%, Europe: 9.6%).
• Pre-transplant dialysis, mechanical circulatory support (MCS), and ischemic time were consistent risk factors for severe PGD.
• Thirty-day and 1-year mortality after severe PGD were significantly lower in the US compared to Canada and Europe.

Conclusions:

• While severe PGD incidence is similar globally, US heart transplant recipients experience better survival outcomes.
• Understanding regional differences in PGD care can inform the development of best practices to enhance post-transplant survival.