Long-Term Effects of Primary Graft Dysfunction after Heart Transplantation

Purpose Primary graft dysfunction (PGD) is a potentially life-threatening complication that may occur in the immediate postoperative period following heart transplantation. We studied the incidence of PGD, its impact on in-hospital and follow-up outcomes and searched for independent risk factors. Methods During an 18-year period (2002-2020), 508 adult individuals underwent isolated heart transplantation at our institution. Patients were diagnosed with none, mild, moderate or severe PGD according to ISHLT criteria. Risk factors for combined moderate/severe PGD were searched with univariate and multivariate analyses. Survival analysis was performed. Results Among the 508 patients, 38 (7.5%) met the ISHLT criteria for mild PGD, 92 (18.1%) for moderate PGD and 23 (4.5%) for severe PGD. Patients were classified into none/mild PGD (393; 77.4%) and moderate/severe PGD (115; 22.6%) groups. Overall in-hospital mortality was 12.4% (7.8% for none/mild PGD and 28.7% for moderate/severe PGD; P Conclusion Our results confirm that PGD is associated with poor in-hospital outcome. Interestingly, the poor outcome doesn't extend beyond the first month of follow-up, with comparable survival between patients with none/mild PGD and moderate/severe PGD in the short and long-term. We found preoperative mechanical circulatory support and preoperative IABP to be independent risk factors for moderate/severe PGD.