Long-Term Effects of Primary Graft Dysfunction after Heart Transplantation

Abstract

<h3>Purpose</h3> Primary graft dysfunction (PGD) is a potentially life-threatening complication that may occur in the immediate postoperative period following heart transplantation. We studied the incidence of PGD, its impact on in-hospital and follow-up outcomes and searched for independent risk factors. <h3>Methods</h3> During an 18-year period (2002-2020), 508 adult individuals underwent isolated heart transplantation at our institution. Patients were diagnosed with none, mild, moderate or severe PGD according to ISHLT criteria. Risk factors for combined moderate/severe PGD were searched with univariate and multivariate analyses. Survival analysis was performed. <h3>Results</h3> Among the 508 patients, 38 (7.5%) met the ISHLT criteria for mild PGD, 92 (18.1%) for moderate PGD and 23 (4.5%) for severe PGD. Patients were classified into none/mild PGD (393; 77.4%) and moderate/severe PGD (115; 22.6%) groups. Overall in-hospital mortality was 12.4% (7.8% for none/mild PGD and 28.7% for moderate/severe PGD; <i>P</i><0.001). Survival at 1, 5 and 15 years was 85.5 ± 1.9% vs. 67.2 ± 4.5%, 80 ± 2.2% vs. 63.5 ± 4.7% and 60.4 ± 3.6% vs. 45.9 ± 8.4%, respectively (<i>P</i><0.001) (figure 1A). When excluding the events occurring during the first month of follow-up, survival was comparable between the two groups (93.1 ± 1.4% vs. 94.7 ± 2.6 at 1 year and 65.6 ± 3.8% vs 70.4 ± 10.4% at 15 years, respectively; <i>P</i>=0.88)(figure 1B). Upon multivariate logistic regression analysis, preoperative mechanical circulatory support (OR=5.86, <i>P</i>=0.029) and preoperative intra-aortic balloon pump (IABP) (OR=9.58, <i>P</i>=0.045) were independently associated with moderate/severe PGD. <h3>Conclusion</h3> Our results confirm that PGD is associated with poor in-hospital outcome. Interestingly, the poor outcome doesn't extend beyond the first month of follow-up, with comparable survival between patients with none/mild PGD and moderate/severe PGD in the short and long-term. We found preoperative mechanical circulatory support and preoperative IABP to be independent risk factors for moderate/severe PGD.