title: Application of the International Society for Heart and Lung Transplantation (ISHLT) criteria for primary graft dysfunction after cardiac transplantation: outcomes from a high-volume centre†.
abstract: A standardized definition for primary graft dysfunction (PGD) after cardiac transplantation was recently proposed by the International Society of Heart and Lung Transplantation (ISHLT). We sought to characterize the outcomes associated with and identify risk factors for PGD following cardiac transplantation using these criteria at a high volume centre.
  
  
  
  Donor and recipient medical records of 201 consecutive adult cardiac transplantations performed between November 2012 and March 2015 were retrospectively reviewed. Patients undergoing isolated heart transplantation were diagnosed with none, mild, moderate, or severe PGD using ISHLT criteria. Cumulative survival was calculated according to the Kaplan–Meier method. Associations of risk factors for combined moderate/severe PGD were assessed with univariate and multivariate analyses.
  
  
  
  A total of 191 consecutive patients underwent isolated heart transplantation, and 59 (30%) met ISHLT criteria for PGD: 35 (18%) mild, 8 (4%) moderate and 16 (8%) severe. Thirty-day/in-hospital mortality occurred in six (3%) patients, all of whom were diagnosed with severe PGD. Patients with moderate/severe PGD also had significantly increased intensive care unit length of stay (LOS), total LOS, reoperations for bleeding and postoperative infections. Survival at 1-year was diminished with increasing severity of PGD (none 93%, mild 94%, moderate 75% and severe 44%; log-rank P < 0.001). Elevated preoperative creatinine, pretransplantation hospitalized recipient and undersized donor were independently predictive of moderate/severe PGD.
  
  
  
  A diagnosis of PGD portends worse outcomes including increased 30-day and 1-year mortality. The ISHLT diagnostic criteria for moderate and severe PGD identify and discriminate patients with PGD in a clinically relevant manner.
authors.affiliation: Baylor Research Institute, Baylor Scott & White Health, Dallas, TX, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Squiers
authors.affiliation: Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Saracino
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Themistokles
authors.initials: T
authors.lastname: Chamogeorgakis
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Juan C
authors.initials: JC
authors.lastname: MacHannaford
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Aldo E
authors.initials: AE
authors.lastname: Rafael
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Gonzalo V
authors.initials: GV
authors.lastname: Gonzalez-Stawinski
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Shelley A
authors.initials: SA
authors.lastname: Hall
authors.affiliation: Baylor Research Institute, Baylor Scott & White Health, Dallas, TX, USA.
authors.forename: J Michael
authors.initials: JM
authors.lastname: DiMaio
authors.affiliation: Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Lima
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects* / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000175:diagnosis* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012955:Societies, Medical; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents