title: Levosimendan for primary graft failure after heart transplantation: a 3-year follow-up.
abstract: BACKGROUND
  Primary graft failure (PGF) is a severe complication responsible for 42% of the in-hospital mortality after heart transplantation. It has been postulated that once 30-day survival is achieved, patients with PGF have no increased risk of death. Levosimendan increases the 30-day survival among patients with PGF. Herein we have reported a 3-year follow-up at a single center of a patient cohort including PGF cases treated with levosimendan.
  
  
  METHODS
  From September 2005 to December 2006 53 patients underwent heart transplantation at our institution, including 12 patients (22.6%) who presented with PGF and were treated with levosimendan using a 24-hour continuous infusion (0.10 μg/kg/min). Risk factors for 1-year and three-year mortality were analyzed using 30-day as well as 1 and 3-year survivals comparing patients with versus without PGF (n = 41).
  
  
  RESULTS
  There were no significant differences in donor age, weight, height, and serum sodium between the groups. However, the ischemia time (259 ± 53 vs 227 ± 50 min; P = .06) and recipient age (51.6 ± 15 vs 41.5 ± 21 years; P = .07) were greater among the PGF patients. The 30-day survival rate was 92% in both groups. After 1 and 3 years, the survival rate was significantly lower among the PGF cohort (50% vs 80.6% and 41.7% vs 80.6%; P < .05) with 86.5% of PGF patients succunding due to non cardiac reasons, predominantly infections.
  
  
  CONCLUSIONS
  Although treatment of PGF with levosimendan increased the 30-day survival, the 1 year and 3-year rates were reduced among this cohort of patients. PGF was associated with poor long-term outcomes, which may be a consequence of systemic malperfusion during the stage of cardiac low-output after transplantation.
authors.affiliation: Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany. abeiras@med.uni-muenchen.de
authors.forename: A
authors.initials: A
authors.lastname: Beiras-Fernandez
authors.forename: F
authors.initials: F
authors.lastname: Kur
authors.forename: I
authors.initials: I
authors.lastname: Kaczmarek
authors.forename: P
authors.initials: P
authors.lastname: Frisch
authors.forename: M
authors.initials: M
authors.lastname: Weis
authors.forename: B
authors.initials: B
authors.lastname: Reichart
authors.forename: F
authors.initials: F
authors.lastname: Weis
mesh_terms: D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005858:Germany; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use*; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000077464:Simendan; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan