title: Report from a consensus conference on primary graft dysfunction after cardiac transplantation.
abstract: Although primary graft dysfunction (PGD) is fairly common early after cardiac transplant, standardized schemes for diagnosis and treatment remain contentious. Most major cardiac transplant centers use different definitions and parameters of cardiac function. Thus, there is difficulty comparing published reports and no agreed protocol for management. A consensus conference was organized to better define, diagnose, and manage PGD. There were 71 participants (transplant cardiologists, surgeons, immunologists and pathologists), with vast clinical and published experience in PGD, representing 42 heart transplant centers worldwide. State-of-the-art PGD presentations occurred with subsequent breakout sessions planned in an attempt to reach consensus on various issues. Graft dysfunction will be classified into primary graft dysfunction (PGD) or secondary graft dysfunction where there is a discernible cause such as hyperacute rejection, pulmonary hypertension, or surgical complications. PGD must be diagnosed within 24 hours of completion of surgery. PGD is divided into PGD-left ventricle and PGD-right ventricle. PGD-left ventricle is categorized into mild, moderate, or severe grades depending on the level of cardiac function and the extent of inotrope and mechanical support required. Agreed risk factors for PGD include donor, recipient, and surgical procedural factors. Recommended management involves minimization of risk factors, gradual increase of inotropes, and use of mechanical circulatory support as needed. Retransplantation may be indicated if risk factors are minimal. With a standardized definition of PGD, there will be more consistent recognition of this phenomenon and treatment modalities will be more comparable. This should lead to better understanding of PGD and prevention/minimization of its adverse outcomes.
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: kobashigawaj@cshs.org.
authors.forename: Jon
authors.initials: J
authors.lastname: Kobashigawa
authors.affiliation: Medical University of Vienna, Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zuckermann
authors.affiliation: St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Macdonald
authors.affiliation: Pierre et Marie Curie University La Pitie-Salpétrière Hospital, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Fardad
authors.initials: F
authors.lastname: Esmailian
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Minh
authors.initials: M
authors.lastname: Luu
authors.affiliation: Columbia University, New York, New York.
authors.forename: Donna
authors.initials: D
authors.lastname: Mancini
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Jignesh
authors.initials: J
authors.lastname: Patel
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Rabia
authors.initials: R
authors.lastname: Razi
authors.affiliation: University Heart Centre, Hamburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.affiliation: Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Stuart
authors.initials: S
authors.lastname: Russell
authors.affiliation: Hospital de Puerta De Hierro, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Segovia
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Smedira
authors.affiliation: University of Utah, Salt Lake City, Utah.
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
authors.affiliation: University Heart Centre, Hamburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Wagner
mesh_terms: D006801:Humans; D003299:Cooperative Behavior; D006084:Graft Rejection / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016027:Heart Transplantation / Q000401:mortality; D033183:Interdisciplinary Communication; D019157:Ischemic Preconditioning, Myocardial; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D055031:Primary Graft Dysfunction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012086:Reoperation; D012307:Risk Factors; D016019:Survival Analysis
keywords: cardiac transplantation; consensus; outcomes; primary graft dysfunction; primary graft failure