title: Primary graft failure after heart transplantation: characteristics in a contemporary cohort and performance of the RADIAL risk score.
abstract: BACKGROUND
  Primary graft failure (PGF) is the leading cause of early heart transplantation (HT) mortality. Our aim was to analyze PGF currently and explore the ability of a dedicated score for PGF risk stratification.
  
  
  METHODS
  After applying a dedicated PGF definition, we analyzed its incidence, mortality, and associated factors in a multicenter cohort of 857 HTs performed in 2006 to 2009. We used the following criteria: recipient right (R) atrial pressure ≥ 10 mm Hg; age (A) ≥ 60 years; diabetes (D) mellitus, and inotrope (I) dependence; donor age (A) ≥ 30 years, and length (L) of ischemia ≥ 240 minutes to calculate the RADIAL score for PGF risk prediction.
  
  
  RESULTS
  PGF incidence was 22%. The right ventricle was almost always affected, alone (45%) or as part of biventricular failure (47%). Mechanical circulatory support was used in 55%. Mortality attributable to PGF was 53% and extended through the third month after HT, but thereafter, PGF had little influence in long-term outcome. The RADIAL score was higher in PGF patients (2.78 ± 1.1 vs. 2.42 ± 1.1, p = 0.001) and stratified 3 groups with incremental PGF incidence: low risk (12.1%), intermediate risk (19.4%), and high risk (27.5%, p = 0.001).
  
  
  CONCLUSIONS
  PGF had a strong impact, with an incidence of 22% and a mortality exceeding 50% that extends through the third post-HT month. The RADIAL score classified patients into 3 groups with incremental risk for PGF and may be useful for its prevention and early therapy.
authors.affiliation: Cardiac Transplant Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid. Electronic address: mdgcosio@secardiologia.es.
authors.forename: M Dolores G
authors.initials: MD
authors.lastname: Cosío Carmena
authors.forename: Manuel
authors.initials: M
authors.lastname: Gómez Bueno
authors.forename: Luis
authors.initials: L
authors.lastname: Almenar
authors.forename: Juan F
authors.initials: JF
authors.lastname: Delgado
authors.forename: Jose M
authors.initials: JM
authors.lastname: Arizón
authors.forename: Francisco
authors.initials: F
authors.lastname: González Vilchez
authors.forename: Maria G
authors.initials: MG
authors.lastname: Crespo-Leiro
authors.forename: Sonia
authors.initials: S
authors.lastname: Mirabet
authors.forename: Eulalia
authors.initials: E
authors.lastname: Roig
authors.forename: Félix
authors.initials: F
authors.lastname: Pérez Villa
authors.forename: Juan F
authors.initials: JF
authors.lastname: Fernández-Yañez
authors.forename: Jose L
authors.initials: JL
authors.lastname: Lambert
authors.forename: Nicolás
authors.initials: N
authors.lastname: Manito
authors.forename: Luis
authors.initials: L
authors.lastname: Fuente
authors.forename: Maria L
authors.initials: ML
authors.lastname: Sanz Julve
authors.forename: Domingo
authors.initials: D
authors.lastname: Pascual
authors.forename: Gregorio
authors.initials: G
authors.lastname: Rábago
authors.forename: Isabel
authors.initials: I
authors.lastname: Millán
authors.forename: Luis A
authors.initials: LA
authors.lastname: Alonso-Pulpón
authors.forename: Javier
authors.initials: J
authors.lastname: Segovia
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000503:physiopathology*; D006325:Heart Atria / Q000503:physiopathology; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014019:Tissue Donors
keywords: complication; early mortality; heart transplantation; primary early graft failure; risk score