Risk factors for primary graft dysfunction after heart transplantation-a systematic review and meta-analysis

Area of Science:

• Cardiology
• Transplantation Surgery
• Medical Research

Background:

• Primary graft dysfunction (PGD) significantly contributes to early mortality following heart transplantation (HTX).
• The International Society for Heart and Lung Transplantation (ISHLT) established a consensus definition for PGD in 2014.
• Identifying PGD risk factors is crucial for improving post-transplant outcomes.

Purpose of the Study:

• To systematically review and meta-analyze published literature to identify risk factors for PGD.
• To apply the ISHLT 2014 consensus definition of PGD in the analysis.
• To determine significant predictors of severe PGD.

Main Methods:

• A systematic literature search was conducted using Medline, Embase, and Cochrane databases, adhering to PRISMA guidelines.
• Studies included adult patients undergoing primary, isolated heart transplantation with PGD specified per the ISHLT definition.
• Meta-analysis was performed on risk factors reported in at least two studies.

Main Results:

• 39 studies were included, revealing significant heterogeneity.
• 37 risk factors for PGD were identified.
• Meta-analysis confirmed recipient amiodarone therapy, female donor sex, prior sternotomy (non-LVAD), LVAD therapy, and cold ischemic time per hour as risk factors for severe PGD.

Conclusions:

• This systematic review identified 37 risk factors for PGD.
• Meta-analysis confirmed specific risk factors for severe PGD, including amiodarone use, donor sex, prior sternotomy, LVAD therapy, and cold ischemic time.
• Blood product administration was associated with severe PGD but excluded from meta-analysis due to definitional heterogeneity.