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

John J. Squiers, Giovanna Saracino, Themistokles Chamogeorgakis, Juan C. MacHannaford, Aldo E. Rafael, Gonzalo V. Gonzalez-Stawinski, Shelley A. Hall, J. Michael DiMaio, Brian Lima

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Original languageEnglish (US)
Pages (from-to)263-270
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume51
Issue number2
DOIs
StatePublished - Feb 1 2017

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Primary Graft Dysfunction
Heart Transplantation
Heart-Lung Transplantation
Length of Stay
Tissue Donors
Survival
Hospital Mortality
Reoperation

Keywords

  • Cardiac transplantation
  • Donor selection
  • Primary graft dysfunction

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

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. / Squiers, John J.; Saracino, Giovanna; Chamogeorgakis, Themistokles; MacHannaford, Juan C.; Rafael, Aldo E.; Gonzalez-Stawinski, Gonzalo V.; Hall, Shelley A.; Michael DiMaio, J.; Lima, Brian.

In: European Journal of Cardio-thoracic Surgery, Vol. 51, No. 2, 01.02.2017, p. 263-270.

Research output: Contribution to journalArticle

Squiers, JJ, Saracino, G, Chamogeorgakis, T, MacHannaford, JC, Rafael, AE, Gonzalez-Stawinski, GV, Hall, SA, Michael DiMaio, J & Lima, B 2017, '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', European Journal of Cardio-thoracic Surgery, vol. 51, no. 2, pp. 263-270. https://doi.org/10.1093/ejcts/ezw271
Squiers, John J. ; Saracino, Giovanna ; Chamogeorgakis, Themistokles ; MacHannaford, Juan C. ; Rafael, Aldo E. ; Gonzalez-Stawinski, Gonzalo V. ; Hall, Shelley A. ; Michael DiMaio, J. ; Lima, Brian. / 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. In: European Journal of Cardio-thoracic Surgery. 2017 ; Vol. 51, No. 2. pp. 263-270.
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abstract = "OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.",
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T1 - Application of the International Society for Heart and Lung Transplantation (ISHLT) criteria for primary graft dysfunction after cardiac transplantation

T2 - Outcomes from a high-volume centre

AU - Squiers, John J.

AU - Saracino, Giovanna

AU - Chamogeorgakis, Themistokles

AU - MacHannaford, Juan C.

AU - Rafael, Aldo E.

AU - Gonzalez-Stawinski, Gonzalo V.

AU - Hall, Shelley A.

AU - Michael DiMaio, J.

AU - Lima, Brian

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N2 - OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

AB - OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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KW - Donor selection

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