Related Experiment Video
Updated: Mar 31, 2026
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Risk factors for primary graft dysfunction after heart transplantation-a systematic review and meta-analysis
Mats T Vervoorn1, Selma E Kaffka Genaamd Dengler1, Elisa M Ballan1,2,3
1University Medical Center Utrecht, Department of Cardiothoracic Surgery, Division of Heart & Lungs, Utrecht, Netherlands.
Insights
Primary graft dysfunction (PGD) after heart transplantation (HTX) is linked to several risk factors. Key predictors of severe PGD include recipient amiodarone therapy, female donor sex, prior sternotomy, LVAD therapy, and longer cold ischemic times.
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.
Background:
Primary graft dysfunction (PGD) is an important contributor to early mortality after heart transplantation (HTX). The International Society for Heart and Lung Transplantation (ISHLT) published a consensus definition of primary graft dysfunction in 2014. We conducted a systematic review and meta-analysis of published literature to identify risk factors for primary graft dysfunction according to this consensus definition.
Methods:
According to PRISMA-guidelines, eligible studies were identified using Medline, Embase, and Cochrane. Studies were included if focused on patients ≥18 years old who received a primary, isolated HTX and outcome was specified as PGD according to the ISHLT consensus definition. Risk factors for severe PGD were included in meta-analysis if reported in ≥2 studies.
Results:
A total of 39 studies were included. Significant heterogeneity was noted. A total of 37 risk factors for PGD were identified. Meta-analysis identified recipient amiodarone therapy, female sex of the donor, recipient prior sternotomy (other than for LVAD implantation), recipient LVAD therapy and cold ischemic time per hour increment as risk factors for severe PGD. Blood product administration was associated with severe PGD in multiple studies, but was excluded from meta-analysis due to heterogeneity in definition.
Conclusion:
In this systematic review, we identified a total of 37 risk factors for PGD, while meta-analysis solidified amiodarone therapy, female sex of the donor, recipient prior sternotomy (other than for LVAD implantation), recipient LVAD therapy and cold ischemic time per hour increment as risk factors for severe PGD. Blood product administration was associated with severe PGD in multiple studies, but was excluded from meta-analysis due to heterogeneity in definition.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
01:27Heart Failure I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:17Pathophysiology of Heart Failure
01:16Kidney Transplant III: Nursing Management