Clinical relevance of the International Society for Heart and Lung Transplantation consensus classification of primary graft dysfunction after heart transplantation: Epidemiology, risk factors, and outcomes

Mario Sabatino, Giuseppe Vitale, Valentina Manfredini, Marco Masetti, Laura Borgese, Giuseppe Maria Raffa, Antonio Loforte, Sofia Martin Suarez, Calogero Falletta, Giuseppe Marinelli, Francesco Clemenza, Francesco Grigioni, Luciano Potena

Research output: Contribution to journalArticle

Abstract

Background Primary graft dysfunction (P-GD) is the leading cause of early mortality after heart transplantation (HT). In this 2-center study we analyze outcomes and risk factors of P-GD according to the recent consensus conference classification endorsed by International Society for Heart and Lung Transplantation. Methods We included all adult HTs performed between 1999 and 2013. P-GD was graded as mild, moderate, and severe, according to International Society for Heart and Lung Transplantation recommendations, and analyzed separately from secondary GD. The primary end point was the combined occurrence of in-hospital death or emergency retransplantation. Results Early GD was found in 118 of 518 patients (23%), and 72 (13.9%) met the criteria for P-GD. Of these, 4 (5%) were mild, 33 (46%) moderate, and 35 (49%) severe and mostly characterized by biventricular involvement (78%). The end point occurred in 53 patients (10.2%). Overall, GD was a strong predictor of death-graft loss (odds ratio, 15.9; 95% confidence interval, 7.9–33.5; p < 0.01), with non-significant worse outcomes in P-GD (37%) vs secondary GD (27%) patients (p = 0.2). The study end point was more frequent in severe P-GD patients (65%) than in moderate (12%) or mild (0%; p < 0.01). Several known risk factors influenced the risk for P-GD, and the combination of specific donor and recipient risk factors accounted for approximately 22-times increased odds for P-GD. Donor age, recipient diabetes, ischemic time, and post-operative dialysis predicted non-recovery from P-GD. Conclusions Consensus-defined P-GD identifies patients at major risk for early death and graft loss after HT, although the “mild” grade appeared under-represented and clinically irrelevant. The amplified negative effect of donor and recipient factors on P-GD risk underscores the need for appropriate donor-recipient match.

Original languageEnglish
Pages (from-to)1217-1225
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume36
Issue number11
DOIs
Publication statusPublished - Nov 1 2017

Keywords

  • early death
  • ECMO
  • heart transplant
  • ISHLT consensus classification
  • organ allocation
  • primary graft dysfunction
  • secondary graft dysfunction

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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