ISHLT primary graft dysfunction incidence, risk factors and outcome: a UK national study

Avtaar Singh, S. S., Banner, N. R., Rushton, S., Simon, A. R., Berry, C. and Al-Attar, N. (2019) ISHLT primary graft dysfunction incidence, risk factors and outcome: a UK national study. Transplantation, 103(2), pp. 336-343. (doi:10.1097/TP.0000000000002220) (PMID:29757910)

Avtaar Singh, S. S., Banner, N. R., Rushton, S., Simon, A. R., Berry, C. and Al-Attar, N. (2019) ISHLT primary graft dysfunction incidence, risk factors and outcome: a UK national study. Transplantation, 103(2), pp. 336-343. (doi:10.1097/TP.0000000000002220) (PMID:29757910)

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Abstract

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 ISHLT established diagnostic criteria for PGD. We studied the incidence of PGD across the UK. Methods: We analysed the medical records of all adult patients who underwent heart transplantation between October 2012-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%) vs 13(4.5%) (p=0.0001). Donor, recipient and operative factors associated with PGD were: recipient diabetes mellitus (p=0.031), recipient preoperative BIVAD(p<0.001) and preoperative ECMO (p=0.023), female donor to male recipient gender mismatch(p=0.007) older donor age (p=0.010) and intracerebral haemorrhage/thrombosis in donor (p=0.023). Intra-operatively, 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 VAD/ECMO support (p=0.012), Conclusion: This is the first national study to examine the incidence and significance of PGD after heart transplantation using the ISHLT definition. PGD remains a frequent early complication of heart transplantation and is associated with increased mortality.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Avtaar Singh, Sanjeet Singh and Al-Attar, Mr Nawwar
Authors: Avtaar Singh, S. S., Banner, N. R., Rushton, S., Simon, A. R., Berry, C., and Al-Attar, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Transplantation
Publisher:Lippincott, Williams & Wilkins
ISSN:0041-1337
ISSN (Online):1534-6080
Published Online:01 May 2018
Copyright Holders:Copyright © 2018 Wolters Kluwer Health
First Published:First published in Transplantation 103(2):336-343
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
617771BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177RI CARDIOVASCULAR & MEDICAL SCIENCES