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.