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Primary Cardiac Allograft Dysfunction-Validation of a Clinical Definition.

Dronavalli VB, Rogers CA, Banner NR - Transplantation (2015)

Bottom Line: We compared the clinical outcome of PGD and non-PGD cases.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).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.

View Article: PubMed Central - PubMed

Affiliation: 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.

ABSTRACT

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.

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Related in: MedlinePlus

Flowchart showing the total number of heart transplants nationally and recruitment to the HEART study.
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Figure 1: Flowchart showing the total number of heart transplants nationally and recruitment to the HEART study.

Mentions: A total of 528 transplants in 520 recipients were performed using hearts from adult donors (aged 16 years or older) during the study period. Of these 528 transplants, donor family consent for the study was given for 314 (59%) (Figure 1), data were not submitted for 11 of these hearts, 10 were transplanted as heart lung blocks, and 3 were a second transplantation carried out within 72 hours of the first; these second heart transplantations were excluded. For the 3 recipients of 2 hearts within 72 hours, the first transplant was considered to have PGD and the recipient classified as having developed PGD regardless of the outcome of the second heart. Of the 301 heart only transplants in the study cohort, 8 were second transplants, the recipients having received their first transplant before the study started (time from first to second transplant ranged from 66 to 2758 days); these were included in the study. Centers classified the recipient as having developed PGD using our prespecified definition, and this was reported to us for 290 of the 301 transplants (see Figure 1). Of the 290 transplant recipients, 94 developed PGD (32.4%; 95% confidence interval, 27.0% to 38.1%), 8 of whom died within 72 hours from PGF.


Primary Cardiac Allograft Dysfunction-Validation of a Clinical Definition.

Dronavalli VB, Rogers CA, Banner NR - Transplantation (2015)

Flowchart showing the total number of heart transplants nationally and recruitment to the HEART study.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4548546&req=5

Figure 1: Flowchart showing the total number of heart transplants nationally and recruitment to the HEART study.
Mentions: A total of 528 transplants in 520 recipients were performed using hearts from adult donors (aged 16 years or older) during the study period. Of these 528 transplants, donor family consent for the study was given for 314 (59%) (Figure 1), data were not submitted for 11 of these hearts, 10 were transplanted as heart lung blocks, and 3 were a second transplantation carried out within 72 hours of the first; these second heart transplantations were excluded. For the 3 recipients of 2 hearts within 72 hours, the first transplant was considered to have PGD and the recipient classified as having developed PGD regardless of the outcome of the second heart. Of the 301 heart only transplants in the study cohort, 8 were second transplants, the recipients having received their first transplant before the study started (time from first to second transplant ranged from 66 to 2758 days); these were included in the study. Centers classified the recipient as having developed PGD using our prespecified definition, and this was reported to us for 290 of the 301 transplants (see Figure 1). Of the 290 transplant recipients, 94 developed PGD (32.4%; 95% confidence interval, 27.0% to 38.1%), 8 of whom died within 72 hours from PGF.

Bottom Line: We compared the clinical outcome of PGD and non-PGD cases.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).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.

View Article: PubMed Central - PubMed

Affiliation: 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.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus