Factors Associated With Primary Graft Failure After Heart Transplantation

Russo, Mark J.; Iribarne, Alexander; Hong, Kimberly N.; Ramlawi, Basel; Chen, Jonathan M.; Takayama, Hiroo; Mancini, Donna; Naka, Yoshifumi

doi:10.1097/tp.0b013e3181e6f1eb

Cited by 212 publications

(180 citation statements)

References 15 publications

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“…14 This complication is associated with a poor prognosis 15 and accounts for a significant proportion of deaths during the early postoperative period after HT.…”

Section: Discussionmentioning

confidence: 99%

Preoperative INTERMACS Profiles Determine Postoperative Outcomes in Critically Ill Patients Undergoing Emergency Heart Transplantation

Barge‐Caballero

Segovia‐Cubero

Almenar‐Bonet

et al. 2013

Circ: Heart Failure

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Background— Postoperative outcomes of patients with advanced heart failure undergoing ventricular assist device implantation are strongly influenced by their preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles. We sought to investigate whether a similar association exists in patients undergoing emergency heart transplantation. Methods and Results— By means of the Spanish National Heart Transplant Registry database, we identified 704 adult patients treated with emergency heart transplantation in 15 Spanish centers between 2000 and 2009. Post-transplant outcomes were analyzed pertaining to patient preoperative INTERMACS profiles, which were retrospectively assigned by 2 blinded cardiologists. Before transplantation, INTERMACS profile 1 (critical cardiogenic shock) was present in 207 patients, INTERMACS profile 2 (progressive decline) in 291, INTERMACS profile 3 (inotropic dependence) in 176, and INTERMACS profile 4 (resting symptoms) was present in 30 patients. In-hospital postoperative mortality rates were, respectively, 43%, 26.8%, and 18% in patients with profiles 1, 2, and 3 to 4 ( P <0.001). INTERMACS 1 patients also presented the highest incidence of primary graft failure (1: 31.3%, 2: 22.3%, 3–4: 21.8%; P =0.03) and postoperative need for dialysis (1: 33.2%, 2: 18.9%, 3–4: 21.5%; P <0.001). Adjusted odds-ratios for in-hospital postoperative mortality were 4.38 (95% confidence interval, 2.51–7.66) for profile 1 versus 3 to 4, 2.49 (95% confidence interval, 1.56–3.97) for profile 1 versus 2, and 1.76 (95% confidence interval, 1.02–3.03) for profile 2 versus 3 to 4. Long-term survival after hospital discharge was not influenced by preoperative INTERMACS profiles. Conclusions— Preoperative INTERMACS profiles determine outcomes after emergency heart transplantation. Results call for a change in policies related to the management of heart transplant candidates presenting with INTERMACS profiles 1 and 2.

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“…14 This complication is associated with a poor prognosis 15 and accounts for a significant proportion of deaths during the early postoperative period after HT.…”

Section: Discussionmentioning

confidence: 99%

Preoperative INTERMACS Profiles Determine Postoperative Outcomes in Critically Ill Patients Undergoing Emergency Heart Transplantation

Barge‐Caballero

Segovia‐Cubero

Almenar‐Bonet

et al. 2013

Circ: Heart Failure

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“…Potential mechanisms by which donor/recipient gender mismatch might affect survival after transplantation include hormonal and genetic differences, antigen development and other immunologic factors, and size. Mismatch has been associated with organ failure [25,27], and results for acute rejection and cardiac allograft vasculopathy in sexmismatched patients are controversial, mainly owing to the large amount of missing results and differences in diagnostic criteria [28]. In our series, the predominant mortality in males with mismatched donors appears to occur at the time of transplant (Figs 1 and 2) and we found that male recipients with sex mismatch presented primary graft dysfunction more frequently than female recipients with sex mismatch (24.8% vs. 18.9%, Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, persisting fetal male cells in the maternal heart (microchimerism) have been reported [36] and could explain why women can tolerate a mismatched heart better than men. In addition, the "undersizing" effect has been suggested as a possible explanation [28], as female hearts are smaller than male hearts even after correction for weight and height [37][38][39]. On the other hand, the "oversizing" effect could improve short-term survival of male donor hearts in female recipients, especially in the presence of elevated pulmonary pressures and risk of right heart failure [28].…”

Section: First Authormentioning

confidence: 99%

Donor/recipient sex mismatch and survival after heart transplantation: only an issue in male recipients? An analysis of the Spanish Heart Transplantation Registry

et al. 2014

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SummaryThe results of studies on the association between sex mismatch and survival after heart transplantation are conflicting. Data from the Spanish Heart Transplantation Registry. From 4625 recipients, 3707 (80%) were men. The donor was female in 943 male recipients (25%) and male in 481 female recipients (52%). Recipients of male hearts had a higher body mass index (25.9 AE 4.1 vs. 24.3 AE 3.7; P < 0.01), and male donors were younger than female donors (33.4 AE 12.7 vs. 38.2 AE 12.3; P < 0.01). No further relevant differences related to donor sex were detected. In the univariate analysis, mismatch was associated with mortality in men (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.06-1.32; P = 0.003) but not in women (HR, 0.91; 95% CI 0.74-1.12; P = 0.4). A significant interaction was detected between sex mismatch and recipient gender (P = 0.02). In the multivariate analysis, sex mismatch was associated with longterm mortality (HR, 1.14; 95% CI 1.01-1.29; P = 0.04), and there was a tendency toward significance for the interaction between sex mismatch and recipient gender (P = 0.08). In male recipients, mismatch increased mortality mainly during the first month and in patients with pulmonary gradient >13 mmHg. Sex mismatch seems to be associated with mortality after heart transplantation in men but not in women.

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“…6,7 To further examine the effect on graft function in a large number of patients through the UNOS database, we used a hard definition of PGF as death or retransplantation within 30 days because of graft failure (not related to rejection, infection, or surgical complications). 11 The results did not show an increased risk of PGF in hearts from donors with elevated troponin. Although the precise reason for these discrepant findings is not clear, it should be noted that all previous analysis were limited by small sample size, single-center experience, and conducted in a previous era of management.…”

Section: Discussionmentioning

confidence: 63%

Donor Troponin and Survival After Cardiac Transplantation

Madan

Saeed

Shin

et al. 2016

Circ: Heart Failure

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Background-Despite a limited supply of organs, only 1 in 3 potential donor hearts is accepted for transplantation. Elevated donor troponin levels have generally been considered a contraindication to heart transplantation; however, the data supporting this practice are limited. Methods and Results-We identified 10 943 adult (≥18 years) heart transplant recipients in the United Network of Organ Sharing (UNOS) database with preserved donor left ventricular ejection fraction (≥50%) and where peak donor troponin I values were available. When analyzed as a continuous variable, there was no association between peak donor troponin levels and recipient mortality up to 1 year follow-up in unadjusted (hazards ratio, 0.999; 95% confidence interval, 0.997-1.002; P=0.856) and adjusted Cox models (hazards ratio, 1.000; 95% confidence interval, 0.997-1.002; P=0.950). Next, we divided the entire cohort into 3 groups based on donor troponin I values: <1 ng/mL (n=7812), 1 to 10 ng/mL (n=2770), and >10 ng/mL (n=361). Using unadjusted and adjusted Cox models and Kaplan-Meier analysis, there was no significant difference in recipient mortality at 30 days, 1 year, 3 years, or 5 years between the 3 groups. Similarly, cardiac allograft vasculopathy up to 5 years and primary graft failure up to 30 days of follow-up post transplant did not differ between the 3 donor troponin groups. The median length of hospital stay post transplant was also similar across groups. Conclusions-Elevated donor troponin I levels in the setting of preserved left ventricular ejection fraction were not associated with intermediate-term mortality, cardiac allograft vasculopathy, or primary graft failure rates in hearts accepted for transplantation. This finding could help expand the donor pool. (Circ Heart Fail. 2016;9:e002909.

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Factors Associated With Primary Graft Failure After Heart Transplantation

Abstract: Pretransplant recipient and donor characteristics are associated with PGF. Identification of risk factors may aid in understanding the mechanisms underlying PGF and in matching recipients with donors in efforts to diminish the high mortality associated with this complication.

Cited by 212 publications

References 15 publications

Preoperative INTERMACS Profiles Determine Postoperative Outcomes in Critically Ill Patients Undergoing Emergency Heart Transplantation

Preoperative INTERMACS Profiles Determine Postoperative Outcomes in Critically Ill Patients Undergoing Emergency Heart Transplantation

Donor/recipient sex mismatch and survival after heart transplantation: only an issue in male recipients? An analysis of the Spanish Heart Transplantation Registry

Donor Troponin and Survival After Cardiac Transplantation

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