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ISHLT Primary Graft Dysfunction Incidence, Risk Factors, and Outcome

A UK National Study

Avtaar Singh, Sanjeet Singh, MRCS1,2; Banner, Nicholas R., MD3; Rushton, Sally, MSc4; Simon, Andre R.2; Berry, Colin, PhD2,5; Al-Attar, Nawwar, PhD, FRCS1

doi: 10.1097/TP.0000000000002220
Original Basic Science—General
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Background Heart transplantation (HTx) remains the most effective long-term treatment for advanced heart failure. Primary graft dysfunction (PGD) continues to be a potentially life-threatening early complication. In 2014, a consensus statement released by International Society for Heart and Lung Transplantation (ISHLT) established diagnostic criteria for PGD. We studied the incidence of PGD across the United Kingdom.

Methods We analyzed the medical records of all adult patients who underwent HTx between October 2012 and October 2015 in the 6 UK heart transplant centers Preoperative donor and recipient characteristics, intraoperative details, and posttransplant complications were compared between the PGD and non-PGD groups using the ISHLT definition. Multivariable analysis was performed using logistic regression.

Results The incidence of ISHLT PGD was 36%. Thirty-day all-cause mortality in those with and without PGD was 31 (19%) versus 13 (4.5%) (P = 0.0001). Donor, recipient, and operative factors associated with PGD were recipient diabetes mellitus (P = 0.031), recipient preoperative bilateral ventricular assist device (P < 0.001), and preoperative extracorporeal membranous oxygenation (P = 0.023), female donor to male recipient sex mismatch (P = 0.007), older donor age (P = 0.010), and intracerebral haemorrhage/thrombosis in donor (P = 0.023). Intraoperatively, implant time (P = 0.017) and bypass time (P < 0.001) were significantly longer in the PGD cohort. Perioperatively, patients with PGD received more blood products (P < 0.001). Risk factors identified by multivariable logistic regression were donor age (P = 0.014), implant time (P = 0.038), female: male mismatch (P = 0.033), recipient diabetes (P = 0.051) and preoperative ventricular assist device/extracorporeal membranous oxygenation support (P = 0.012).

Conclusions This is the first national study to examine the incidence and significance of PGD after HTx using the ISHLT definition. PGD remains a frequent early complication of HTx and is associated with increased mortality.

The incidence and significance of primary graft dysfunction (PGD) after heart transplantation are examined in the 6 UK heart transplant centers using the ISHLT definition and PGD remains a frequent early complication of heart transplantation and is associated with increased mortality.

1 Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom.

2 Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom.

3 Transplant and Mechanical Circulatory Support, Harefield Hospital, London, United Kingdom.

4 Statistics and Clinical Studies, National Health Service Blood and Transplant (NHSBT), Bristol, United Kingdom.

5 Research and Development, Golden Jubilee National Hospital, Glasgow United Kingdom.

Received 5 September 2017. Revision received 26 January 2018.

Accepted 27 January 2018.

S.S.A.S. and C.B. are supported by British Heart Foundation Centre of Excellence Award (grant reference RE-13-5-30177).

The authors declare no conflicts of interest.

S.S.A.S. participated in research design, writing of the article, performance of research, and data analysis. N.R.B. participated in research design, writing of the article. S.R. participated in research design and data analysis. A.S. participated in the performance of research. C.B. participated in the writing of the article, performance of research. N.A. participated in the research design, writing of the article.

Correspondence: Sanjeet Singh Avtaar Singh, MRCS, Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom. (sanjeetsingh@nhs.net).

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