Combined Procurement of Heart and Lungs is Associated with an Increased Risk of Primary Graft Dysfunction after Heart Transplantation Compared to Isolated Heart Procurement

Abstract

<h3>Purpose</h3> Combined heart and lungs (CHL) procurement differs from isolated heart (IH) procurement in several aspects, including lung recruitment, cannulation and preservation requirements. We aimed to investigate whether CHL vs IH procurement contributes to the development of primary graft dysfunction (PGD) after heart transplantation (HT). <h3>Methods</h3> Between 1999 and 2019, we assessed 175 HT patients at a single center. Patients were divided into isolated heart (IH, n=61) or combined heart and lung (CHL, n=114) procurement groups. Endpoints included PGD (defined according to the ISHLT consensus statement) and long-term survival. <h3>Results</h3> The incidence of PGD was significantly higher in CHL recipients compared to IH recipients (53.5% vs 16.4%, p<0.001). Multivariable analysis showed that CHL procurement was independently associated with a significant fourfold increased risk for PGD (OR = 4.0, 95%CI 1.62-10.73, Figure). Kaplan-Meier survival analysis showed that overall survival was significantly lower for the CHL group (78.1 vs 91.8%, log-rank p=0.016, Figure). Consistently, multivariable analysis demonstrated CHL to be a predictor for late mortality (HR 2.92, 95%CI 1.09-7.83, p=0.003). The simultaneous procurement of abdominal organs was not associated with an increased risk of PGD in HT recipients. <h3>Conclusion</h3> Combined procurement of heart and lungs is independently associated with an increased risk of PGD. Further prospective studies are needed to validate this hypothesis-generating study and to elucidate the underlying mechanisms.