4 years ago

Primary Graft Dysfunction after Heart Transplantation: Incidence, Trends and Associated Risk Factors

Chetan B. Patel, Jacob Schroeder, Adam Kretzer, Alina Nicoara, Mark Stafford-Smith, David Ruffin, Joseph G. Rogers, Adrian F. Hernandez, Raquel R. Bartz, Mihai V. Podgoreanu, Mani A. Daneshmand, Carmelo A. Milano, Annemarie Thompson, Mary Cooter, Madhav Swaminathan
Changes in heart transplant (HT) donor and recipient demographics may influence the incidence of primary graft dysfunction (PGD). We conducted a retrospective study to evaluate PGD incidence, trends, and associated risk factors by analyzing consecutive adult patients who underwent HT between January 2009 and December 2014 at our institution. Patients were categorized as having PGD using the International Society of Heart and Lung Transplantation defined criteria. Variables, including clinical and demographic characteristics of donors and recipients, were selected to assess their independent association with PGD. A time-trend analysis was performed over the study period. Three-hundred seventeen patients met inclusion criteria. Left ventricular PGD, right ventricular PGD or both were observed in 99 (31%) patients. Risk factors independently associated with PGD included ischemic time, recipient African-American race, and recipient amiodarone treatment. Over the study period, there was no change in the PGD incidence, however there was an increase in the recipient pre-transplant use of amiodarone. The rate of 30-day mortality was significantly elevated in those with PGD vs those without PGD (6.06% vs 0.92%, P=0.01). Despite recent advancements, incidence of PGD remains high. Understanding associated risk factors may allow for implementation of targeted therapeutic interventions. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/ajt.14588

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