1-Year Graft Function and Hemodynamics in Heart Transplant Patients Who Experienced Severe Primary Graft Dysfunction

Abstract

Purpose We have reported that severe primary graft dysfunction (PGD) can be treated by early use of extracorporeal membrane oxygenation (ECMO) support. However, little is known in detail about graft function and hemodynamics in heart transplant patients who survived severe PGD. Methods We retrospectively reviewed 20 adult patients who experienced severe PGD after heart transplant and treated with ECMO between January 2015 and October 2017. Right and left heart catheterization and echocardiographic data at 1-year after transplant was retrospectively reviewed. Results Median age of cohort was 61 years (Interquartile range (IQR) 55-66), and 17 (85%) were male. Nineteen (95%) were bridge to transplant and median duration of device support was 463 days (IQR 246-770). Median donor age was 34 years (IQR 26-43) and baseline donor ejection fraction was 65%. Median duration of ECMO support was 5.1 days (IQR 3.5-8.4) and all weaned from ECMO support. At 1-year, all patients survived (95%), except for one who died in the hospital. No one developed significant allograft vasculopathy on left heart catheterization. On echocardiogram, left ventricular ejection fraction was 60% (IQR 60-65) and 3 patients had mild right ventricular dysfunction. Right heart catheterization showed central venous pressure of 5.5 mmHg (IQR 4-10), mean pulmonary artery pressure of 22 mmHg (IQR 17-23), pulmonary capillary wedge pressure of 12.5 mmHg (IQR 8-14), and cardiac output of 6.4 L/min (IQR 4.7-6.8). Conclusion Allografts which overcame severe PGD can function normally at 1-year follow-up. Adequate perioperative management of severe PGD is mandatory to maximize survival.