title: Predictive risk factors for primary graft failure requiring temporary extra-corporeal membrane oxygenation support after cardiac transplantation in adults.
abstract: OBJECTIVE
  Primary graft failure (PGF) is a major risk factor for death after heart transplantation. We investigated the predictive risk factors for severe PGF that require extra-corporeal membrane oxygenation (ECMO) circulatory support after cardiac transplantation.
  
  
  METHODS
  Between January 2003 and December 2008, 402 adult patients underwent isolated cardiac transplantation at our institution. PGF was defined as the need for ECMO support in the immediate postoperative period. Thirty-three recipient and 37 donor variables were analyzed for the risk of PGF occurrence.
  
  
  RESULTS
  PGF occurred in 91 (23%) patients. Predictive risk factors for PGF occurrence were, in the recipient, being aged >60 years (odds ratio (OR) 2.11, p=0.01) and preoperative mechanical circulatory support (MCS) (OR 2.65, p=0.01); in the donor, they were mean norepinephrine dose (OR 2.02, p<0.01), trauma as the cause of death (OR 2.45, p<0.01), left-ventricle ejection fraction (LVEF) <55% (OR 2.72, p=0.02), and the ischemic time (OR 1.01, p<0.01). Weaning and discharge rates after ECMO support for PGF were, respectively, 60% (55/91 patients) and 46% (42/91 patients). The absence of PGF was correlated with improved long-term survival: 78% at 1 year and 71% at 5 years without PGF versus 39% at 1 year and 34% at 5 years with PGF (p<0.01). Surviving patients treated with ECMO for PGF have similar conditional 1-year survival rates as non-PGF patients: 93% at 3 years and 91% at 5 years without PGF versus 93% at 3 years and 84% at 5 years with PGF (p=0.46, NS).
  
  
  CONCLUSIONS
  Occurrence of PGF is a multifactorial event that depends on both donor and recipient profiles. ECMO support is a reliable treatment for severe PGF; furthermore, surviving patients treated with ECMO have the same 1-year conditional survival rates as patients not having suffered a PGF.
authors.affiliation: Université Pierre et Marie Curie, Paris VI, APHP, Groupe Hospitalier Pitié-Salpétrière, Institute of Cardiology, Division of Thoracic and Cardiovascular Surgery, Paris, France. cosimodalessandro@wanadoo.fr
authors.forename: Cosimo
authors.initials: C
authors.lastname: D'Alessandro
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Golmard
authors.forename: Eleodoro
authors.initials: E
authors.lastname: Barreda
authors.forename: Mojgan
authors.initials: M
authors.lastname: Laali
authors.forename: Ralouka
authors.initials: R
authors.lastname: Makris
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
mesh_terms: D000328:Adult; D000367:Age Factors; D004812:Epidemiologic Methods; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000209:etiology* / Q000628:therapy; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D014019:Tissue Donors; D014021:Tissue Preservation / Q000379:methods