Primary Graft Failure after Heart Transplantation: Risk Factors Analysis and Long Term Results

Purpose: Primary graft failure(PGF)is the most feared complication
in the immediate postoperative period of heart transplantation .It
manifests as a severe systolic dysfunction of the graft- left, right or
biventricular- requiring high inotropic doses with or without
mechanical circulatory support. This is a retrospective single-center
study aimed to define the impact of PGF in our population and to
identify any possible predictive factors in order to enable its
anticipation and early treatment.
Methods andMaterials: PGF was defined by four criteria reflecting
significant myocardial dysfunction, severe hemodynamic impairment,
early onset after heart transplantation, and absence of secondary
causes of graft dysfunction. More than 50 recipients, donors, and peri-
procedural variables were entered in a database. We performed an
univariate analysis of factors associated with the occurrence of PGF.
Variables associated with PGF were included in a multivariate analysis
in order to identify independent predictors of PGF.
Results: The study population consists of a series of 174 consecutive
heart transplantations performed in our institution between January
2005 andDecember2011.34patients(19%) had a PGF after
transplantation, with a 30-day mortality of 47.06%. The analysis of
donor and recipient characteristics has identified seven negative
predictors: recipient age greater than 60years, inotropes, IABP,
MCS or mechanical ventilation before surgery, urgent transplantation
and traumatic donor death(p o 0,01). Patients with three or more of
these risk factors have a chance of developing PGD three times higher
than other patients(c-statistic ¼ 0,71) and a 30-days mortality
increased by3times(c-statistic ¼ 0,74).
Conclusions: PGF confirmed to be a serious complication of the
immediate postoperative period of cardiac transplantation with a
mortality rate in our population of about 47%.The validation of
predictive factors with a larger, prospective study would allow
easier prevention of PGF and a nearly treatment oft his serious
complication.