Primary Graft Dysfunction After Heart Transplantation: Incidence and Current Risk Factors

Abstract

<h3>Purpose</h3> Primary graft dysfunction (PGD) is a leading cause of perioperative mortality in heart transplant (HT). Yet the impact of the current increased use of high-risk recipients and donors for HT on the incidence of PGD is unknown. <h3>Methods</h3> This is a retrospective single-center study of adult patients who underwent isolated heart or heart-kidney transplant from January 2018 to March 2020 to evaluate the incidence and patient characteristics associated with PGD, as defined by the International Society for Heart and Lung Transplantation consensus guidelines. Baseline characteristics and postoperative outcomes were compared between patients with no/mild PGD versus moderate/severe PGD. Multivariate logistic regression was used to determine independent predictors of PGD. <h3>Results</h3> One-hundred seventeen patients were evaluated: 105 (89.7%) had no/mild PGD and 12 (10.3%) had moderate/severe PGD. Patients with moderate/severe PGD were less likely to be bridged to transplant with temporary mechanical circulatory support (MCS) (8.3% versus 55.2%, p=0.002) and were more likely to receive undersized hearts (donor/recipient weight ratio 0.93±0.14 versus 1.12±0.26, p=0.008). Moderate/severe PGD patients had a higher postoperative median vasoactive inotropic score (24.97 versus 6.50, p<0.001) and only one moderate/severe PGD patient required postoperative extracorporeal membrane oxygenation (ECMO). By multivariate analysis, undersized donor (odds ratio [OR] 1.055; 95% confidence interval [CI] 1.003-1.127, p<0.001) was an independent predictor of PGD and pre-transplant temporary MCS was a negative predictor of PGD (OR 0.075; 95% CI 0.003-0.580, p=0.033). <h3>Conclusion</h3> In this experience with HT in high acuity recipients, the incidence of moderate/severe PGD is low and need for post-transplant ECMO is rare. Interestingly, these data suggest that use of pre-transplant temporary MCS may be protective against moderate/severe PGD, and further investigation of this approach is indicated.