Summary of the International Society for Heart and Lung Transplantation (ISHLT) Consensus Conference on Graft...

Primary graft dysfunction (PGD), defined as ventricular dysfunction occurring within 24 hours after heart transplantation (HTx) in the absence of identifiable secondary causes, remains a major contributor to early post-transplant mortality. Over the past decade, there has been a growing understanding of the burden of PGD, the clinical relevance of PGD classification and severity grading, and efforts to identify donor-, recipient-, and procedural-related risk factors and biomarkers predictive of PGD. Significant advancements have been made in donor heart preservation and procurement technologies, as well as in utilization and outcomes of mechanical circulatory support for managing severe PGD patients. However, existing risk-stratification tools have limitations and perform poorly in predicting PGD in the contemporary era. In addition, prevention and management strategies of PGD remain variable, largely influenced by center-specific practices and the lack of objective data. Moreover, vasoplegia often co-exists with PGD, and their complex interplay remains incompletely understood. To address these gaps, a consensus conference was organized on April 9, 2024, endorsed by the International Society for Heart and Lung Transplantation. The conference represented a collaborative multidisciplinary effort by international experts in cardiothoracic transplantation to reassess the consensus definition and grading of PGD, established more than a decade ago, and provide guidance on the utility of risk stratification tools, potential strategies to mitigate the risk of PGD, and the efficacy of current treatment options. The nature of this consensus is to establish a foundation and pave the way for future studies. Findings and consensus statements are presented.