Sensitization is Independently Associated with Increased Risk of Primary Graft Dysfunction After Heart Transplantation

Abstract

<h3>Purpose</h3> Primary graft dysfunction (PGD) is a leading cause of early morbidity and mortality following heart transplantation (HT). We sought to determine the association between pre-transplant calculated panel reactive antibody (cPRA) value and the incidence of PGD while controlling for other known risk factors. <h3>Methods</h3> Consecutive adult HT recipients (n=672) from 1/2015 to 12/2019 at two high-volume centers were included. Definition and severity PGD were based on the 2014 ISHLT consensus statement. Peak cPRA values were collected for each patient prior to HT and high cPRA was defined as >50%. The primary outcome was the incidence of all PGD. Multi-variable logistic regression model was used to identify risk factors for PGD. <h3>Results</h3> The cohort was predominantly male (72.3%), with a mean age of 54.3±12.1 years and 23.1% had a durable left ventricular assist device as a bridge to HT. There were 150 (22.3%) cases of all PGD. Severe PGD occurred in 44 (6.6%) and mild-moderate PGD occurred in 106 (15.8%) patients. A total of 105 (15.6%) patients had high cPRA prior to HT. Univariable model identified PGD risk factors including ischemic time greater than 4 hours, pre-HT angiotensin-converting enzyme inhibitors/angiotensin receptor blockers with and without neprilysin inhibitor use, donor and recipient age, and predicted heart mass ratio <0.86. Multivariable modeling showed that high cPRA was associated with increased incidence of all PGD (OR 1.72, 95% CI 1.07-2.76, p=0.025) when adjusted for co-variates (Table 1). Patients with no cPRA (0%) had significantly lower incidence of severe PGD compared to those with any detectable cPRA (>0%) (4.78 vs. 10.2%, p=0.018). <h3>Conclusion</h3> Patients with high pre-HT cPRA is associated with increased incidence of PGD, after adjustment for donor and recipient characteristics.