PRIMARY GRAFT FAILURE FOLLOWING HEART TRANSPLANTATION

Abstract

394 Objective (s): Primary graft failure (PGF) is a catastrophic event that often leads to death. We sought to determine the incidence of primary graft failure (PGF) following heart transplantation since adopting University of Wisconsin (UW) solution for donor flush preservation. Methods: A retrospective survey, between January 1992 and June 1998, of 545 consecutive orthotopic heart transplants was conducted. During this period we expanded our donor pool by recruiting older and marginal donor organs and initiating an alternate recipient pool. The myocardium was protected with moderate hypothermia, topical endocardial cooling, warm leukocyte-depleted aspartate/glutamate enriched cardioplegia and warm leukocyte-depleted blood reperfusion. Results: The mean age of this group was 47.2 (range, 0.08 to 72 years). The male/female ratio was 9 to 1. Sixty-two (11.4%) recipients were under 18 years of age and 8 (1.5%) were infants under a year old. The remaining 483 patients (88.6%) were adults. Twenty-one patients (21/545) experienced early primary graft failure for an incidence of 3.8%. Graft rescue was attempted with intra-aortic balloon pump (IABP) in 57% (12/21), LVAD in 5% (1/21), RVAD in 5% (1/21) and ECMO in 33% (7/21). Fifty-two percent (11/21) of failing grafts recovered with mechanical support. The overall hospital mortality for this series was 7.7 % (42/545). There have been 82/545 (15%) late deaths over a mean follow-up period of 41.7m (range, 5.9 - 83.6m). Conclusions: Primary allograft failure is a devastating complication occurring in 3.8% of our transplant patients. The high mortality rate is reversible with expeditious mechanical support in over half of these patients.