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

Sabatino, M.; Vitale, Giuseppe; Manfredini, V.; Masetti, M.; Borgese, L.; Raffa, Giuseppe Maria; Loforte, Antonio; Suàrez, Sofia Martìn; Falletta, Calogero; Marinelli, Giuseppe; Clemenza, Francesco; Grigioni, Francesco; Potena, Luciano

doi:10.1016/j.healun.2017.02.014

Cited by 68 publications

(93 citation statements)

References 17 publications

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“…With application of the adult ISHLT criteria for moderate and severe PGD after pediatric cardiac transplantation, moderate/severe PGD occurred frequently in children in the current era (16.3%). This incidence is similar to that reported by studies after application of these guidelines in adults, with PGD ranging from 9%‐32% . A previous assessment of PGD from our institution in an earlier era (1986‐2001), similarly defined by need for MCS or high‐dose inotropes, to be 32.7% overall.…”

Section: Discussionsupporting

confidence: 87%

“…In 2014, ISHLT consensus guidelines were published defining standardized criteria for PGD, as well as allowing for classification of severity . Since this publication, several adult centers have validated these criteria, primarily in single‐center series, with prevalence ranging from 9%‐32% . They also have demonstrated increased mortality in patients with moderate as well as severe PGD.…”

Section: Introductionmentioning

confidence: 99%

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Moderate‐severe primary graft dysfunction after pediatric heart transplantation

Mowers

Simpson

Gazit

et al. 2019

Pediatric Transplantation

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Background PGD is a complication after heart transplantation (OHT) and a significant cause of mortality, particularly in infant recipients. Lack of standardized definition of PGD in the pediatric population makes the prevalence and magnitude of impact unclear. Methods ISHLT PGD consensus guidelines, which include inotrope scores and need for MCS, were applied retrospectively to 208 pediatric OHT recipients from a single institution from 1/2005‐5/2016. PGD was defined as: moderate PGD—inotrope score >10 on postoperative day 1 (24‐48 hours), and severe PGD—MCS within 24 hours (in the absence of detectable rejection). Results PGD occurred in 34 patients (16.3%); 14 of which had severe PGD (6.7%). Multivariate risk factors for PGD included CPB time (OR 10.3/10 min, 95% 10.05, 10.2, P = 0.03), Fontan palliation (OR 1.9, 95% 1.2, 3.97), and PCM (OR 5.65, 95% 1.52, 22.4); but not age, weight, ischemic time, or donor characteristics. Upon sub‐analysis excluding patients with PCM, increased CPB was a significant multivariate risk factor (OR 10.09, 95% 9.89, 10.12, P = 0.003). Patients with PGD had decreased discharge survival compared to those without PGD (85% vs 96%, P < 0.01). Severe PGD was associated with the poorest 1‐year survival (57% vs 91% without PGD, P = 0.04). Conclusion Patients with prolonged CPB are potentially at risk for developing PGD. Neither infant recipients nor donor characteristics were associated with an increased risk of PGD in the current era.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Moderate‐severe primary graft dysfunction after pediatric heart transplantation

Mowers

Simpson

Gazit

et al. 2019

Pediatric Transplantation

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“…The PGD consensus statement by the ISHLT committee was used to retrospectively determine the diagnosis and degree of PGD by evaluating patients' clinical, echocardiographic, and hemodynamic data within 24 hours after heart transplantation. 1 The new grading system defines severe PGD as the requirement of mechanical circulatory support except for intraaortic balloon pump. At our center, all patients with severe PGD were managed with extracorporeal membrane oxygenation (ECMO).…”

Section: Definition Of Pgdmentioning

confidence: 99%

“…Primary graft dysfunction (PGD) remains the leading cause of mortality in patients post‐orthotopic heart transplantation (OHT) . Total incidence of PGD has been found to be 7.4%, with a 30‐day and 1‐year mortality of 30% and 34.6%, respectively .…”

Section: Introductionmentioning

confidence: 99%

Discontinuing amiodarone treatment prior to heart transplantation lowers incidence of severe primary graft dysfunction

Hoemann

Takayama

Jennings

et al. 2020

Clinical Transplantation

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Background Recent studies have shown an increased incidence of primary graft dysfunction (PGD) in patients treated with amiodarone prior to orthotopic heart transplant (OHT). We hypothesized that discontinuation of amiodarone before OHT may lower the incidence of severe PGD. Methods This was a single‐center retrospective study of 381 adult OHT recipients between January 2010 and June 2017. Within 6 months prior to OHT, 197 did not receive amiodarone (Group 1), 142 continued amiodarone to OHT (Group 2), and 42 had amiodarone treatment discontinued before OHT (Group 3). Results 53 (13.9%) participants developed severe PGD, 13 (6.6%) of which were in Group 1, 36 (25.4%) were in Group 2, and 4 (9.5%) were in Group 3 (P < .001). Multivariable analysis revealed continued amiodarone treatment to OHT (Group 2; OR, 3.70; 95% CI, 1.26‐10.88; P = .018) to be an independent risk factor for the development of severe PGD when Group 1 served as the reference group. Moreover, patients in Group 3 had no difference in the risk of severe PGD (OR = 0.416, 95% CI = 0.08‐2.15; P = .296). Conclusion We found that discontinuing amiodarone treatment prior to OHT resulted a lower incidence of severe PGD.

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“…The incidence of severe primary graft dysfunction in our study is comparable to previous reports in adult HTx recipients. Studies by Sabatino et al and Takeda et al reported that severe primary graft dysfunction occurred in 6.8% and 7.4% of HTx recipients, respectively . Similarly, a single center analysis of pediatric HTx recipients reported an incidence of primary graft dysfunction of 8.4% (17 out of 203 patients) .…”

Section: Discussionmentioning

confidence: 92%

Extracorporeal membrane oxygenation use in the first 24 hours following pediatric heart transplantation: Incidence, risk factors, and outcomes

Godown

Bearl

Thurm

et al. 2019

Pediatric Transplantation

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Primary graft dysfunction following HTx is associated with significant morbidity and mortality. This study aimed to assess the incidence of, risk factors for, and outcomes of children requiring ECMO within 24 hours of HTx. This study utilized a linked PHIS/SRTR database of pediatric HTx recipients (2002‐2016). Post‐HTx ECMO was identified using inpatient billing data. Logistic regression assessed risk factors for post‐HTx ECMO. Kaplan‐Meier analyses assessed in‐hospital mortality and post‐discharge survival. A total of 2820 patients were included with 224 (7.9%) requiring ECMO. Independent risk factors for post‐HTx ECMO include age <1 year (aOR: 2.2, 95% CI: 1.3‐3.7, P = 0.006) or 1‐5 years (aOR: 2.1, 95% CI: 1.3‐3.4, P = 0.002), and ECMO support at HTx (aOR: 27.4, 95% CI: 15.2‐49.6, P < 0.001). Survival to discharge decreased with increasing duration of post‐HTx ECMO support; 89% for 1‐3 days, 79.1% for 4‐6 days, 63.2% for 7‐9 days, and 18.8% for ≥10 days. There was no difference in long‐term survival for patients requiring post‐HTx ECMO who survived to hospital discharge (P = 0.434). There are identifiable risk factors associated with the need for ECMO in the post‐HTx period. Length of time on ECMO post‐HTx is strongly associated with the risk of in‐hospital mortality. Patients who require ECMO early post‐HTx and survive to discharge have comparable outcomes to patients who did not require ECMO.

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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

Cited by 68 publications

References 17 publications

Moderate‐severe primary graft dysfunction after pediatric heart transplantation

Moderate‐severe primary graft dysfunction after pediatric heart transplantation

Discontinuing amiodarone treatment prior to heart transplantation lowers incidence of severe primary graft dysfunction

Extracorporeal membrane oxygenation use in the first 24 hours following pediatric heart transplantation: Incidence, risk factors, and outcomes

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