Primary Cardiac Allograft Dysfunction-Validation of a Clinical Definition.
BACKGROUND
Heart transplantation is an established treatment for advanced heart failure. Primary allograft dysfunction (PGD) is reported in up to 40% of transplants and is associated with a poor outcome.


METHODS
As part of Heart Evaluation and Retrieval for Transplantation study, an investigation of the assessment of donor hearts for transplantation, we proposed a clinical definition for cardiac PGD comprising severely impaired systolic function affecting one or both ventricles accompanied by hypotension, low cardiac output, and high filling pressures occurring in the first 72 hours (in the absence of hyper acute rejection and technical surgical factors, such as cardiac tamponade). Here, we examine the prospective application of this definition to 290 heart transplants. We compared the clinical outcome of PGD and non-PGD cases.


RESULTS
Ninety-four of 290 transplants developed PGD (32.4%). Inotrope use (score) was higher in the PGD group at 24, 48, and 72 hours after transplantation (P < 0.01). In the PGD group, there was a greater requirement for, intra-aortic balloon pump (50% vs 15%, P < 0.01), mechanical support (27% vs 0%, P < 0.01), and renal replacement therapy (61% vs 26%, P < 0.01). Intensive care stay was longer for recipients with PGD (median 14 vs 5 days, P < 0.01) and early mortality was higher (37% vs 4% at 30 days, 42% vs 8% at 1 year, P < 0.01).


CONCLUSIONS
In conclusion, our definition of PGD could be applied in a national multicenter study, and the cases it defined had more frequent complications and higher mortality.
1 University Hospital Birmingham Queen Elizabeth Hospital, Birmingham, United Kingdom. 2 The University of Birmingham, Edgbaston, Birmingham, United Kingdom. 3 Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom. 4 The Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom. 5 National Heart and Lung Institute and Institute of Cardiovascular Medicine and Research, Imperial College, London, United Kingdom. 6 Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom.
Vamsidhar B
VB
Dronavalli
Chris A
CA
Rogers
Nicholas R
NR
Banner
D000328:Adult; D002303:Cardiac Output, Low / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D055031:Primary Graft Dysfunction / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D009626:Terminology as Topic; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
D002316:Cardiotonic Agents