Persistent primary graft dysfunction stratifies risk after heart transplantation with lower mortality among...

Area of Science:

• Cardiology
• Transplantation Surgery
• Immunology

Background:

• Donation after circulatory death (DCD) heart transplantation increases donor availability.
• Primary graft dysfunction (PGD) is more common in DCD than donation after brain death (DBD) recipients.
• Early survival rates are often similar, suggesting differences in PGD prognosis based on donor type.

Purpose of the Study:

• To investigate the impact of PGD course on early survival after heart transplantation.
• To compare outcomes between DCD and DBD donors in recipients experiencing persistent PGD.

Main Methods:

• Analysis of UNOS STAR data for adult isolated heart transplants (Sept 2023 - Oct 2025).
• Categorization of PGD course as none, transient (24h), or persistent (24/72h).
• Cox models and propensity-score matching to evaluate mortality hazard associated with PGD and donor type.

Main Results:

• Persistent PGD was associated with increased mortality hazard (aHR 2.25) compared to no PGD.
• Transient PGD did not significantly impact mortality.
• Within persistent PGD, DCD donors had a lower mortality hazard than DBD donors (aHR 0.59).

Conclusions:

• The 72-hour PGD course effectively stratifies early post-transplant risk.
• Recipients with persistent PGD experience more favorable early survival with DCD donors compared to DBD donors.
• Persistent PGD remains a high-risk factor irrespective of the donor type.