Recipient and Donor Risk Factors Associated with Primary Graft Failure Requiring Temporary Mechanical Circulatory Support < 24 Hours After Heart Transplantation

Primary graft failure (PGF) is a devastating complication that occurs in the immediate postoperative period following heart transplantation. It manifests as severe ventricular dysfunction of the donor graft and carries significant mortality and morbidity. In the last decade, advances in pharmacological treatment and mechanical circulatory support have improved the outlook for heart transplant recipients who develop this complication. Despite these advances in treatment, PGF is still the leading cause of death in the first 30 days after transplantation. In today's climate of significant organ shortages and growing waiting lists, transplant units worldwide have increasingly utilised “marginal donors” to try and bridge the gap between “supply and demand.” One of the costs of this strategy has been an increased incidence of PGF. As the threat of PGF increases, the challenges of predicting and preventing its occurrence, as well as the identification of more effective treatment modalities, are vital areas of active research and development.

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Impact of temporary mechanical circulatory support for early graft failure on post–heart transplantation outcomes

Clinical Transplantation ◽

10.1111/ctr.14060 ◽

2020 ◽

Vol 34 (11) ◽

Cited By ~ 1

Author(s):

Marian Urban ◽

Scott W. Lundgren ◽

Aleem Siddique ◽

Timothy R. Ryan ◽

Brian D. Lowes ◽

...

Keyword(s):

Heart Transplantation ◽

Graft Failure ◽

Mechanical Circulatory Support ◽

Circulatory Support ◽

Early Graft ◽

Transplantation Outcomes ◽

Early Graft Failure

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Mechanical Circulatory Support after Orthotopic Heart Transplantation

The International Journal of Artificial Organs ◽

10.1177/039139889802100712 ◽

1998 ◽

Vol 21 (7) ◽

pp. 414-416 ◽

Cited By ~ 29

Author(s):

G. Tenderich ◽

M.M. Koerner ◽

B. Stuettgen ◽

K. Minami ◽

A. El-Banayosy ◽

...

Keyword(s):

Heart Failure ◽

Graft Failure ◽

Mechanical Circulatory Support ◽

Right Heart Failure ◽

Left Ventricular ◽

Circulatory Support ◽

Right Heart ◽

Primary Graft Failure ◽

Ventricular Support ◽

Mechanical Assist

Frequently the only therapy for primary graft- and right heart failure, as well as low output syndrome from acute of chronic rejection, is implantation of a mechanical circulatory support system, until recompensation or retransplantation. At our institution, mechanical assist devices were implanted in 25 heart recipients for a cute rejection (n=9), primary graft failure (n=7), acute right heart failure (n=7), and chronic rejection with low output syndrome (n=2). Patients (pts) with primary graft failure (n=3) received an intraaortic balloon pump (IABP), one pt an IABP plus Abiomed®-System for left ventricular support, one pt the Thoratec®-System for biventricular support. Patients with right heart failure (RHF) received the Biomedicus® centrifugal pump for right ventricular support. Nine pts suffered from acute rejection. Six pts received an IABP, one the Biomedicus® as femoro-femoral bypass, one the Abiomed®-System for biventricular support, two the Thoratec®-System for biventricular support and two within this group switched from the Biomedicus® pump to the Thoratec®-System for biventricular support. Patients with chronic graft failure (n=2) received the Novacor®-System (LVAD) for left ventricular support, one received a Tojobo®-System and an oxygenator for biventricular support post coronary artery bypass surgery. Support time ranged from 0.5-h to 73 days. Five pts were weaned. Two (8%) of 25 pts were retransplanted, 18 (72%) died in spite of mechanical support from multiple organ failure. The use of a mechanical assist device after heart transplantation is encouraging only in the case of early right heart failure, as well as primary and chronic graft failure. In view of the poor results, the use of mechanical assist devices should not be recommended in the case of heart failure caused by acute rejection.

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Risk Factors and Prognosis of Patients With Primary Graft Failure After Heart Transplantation: An Asian Center Experience

Transplantation Proceedings ◽

10.1016/j.transproceed.2013.11.107 ◽

2014 ◽

Vol 46 (3) ◽

pp. 914-919 ◽

Cited By ~ 10

Author(s):

J.-W. Chen ◽

Y.-S. Chen ◽

N.-H. Chi ◽

S.-C. Huang ◽

H.-Y. Yu ◽

...

Keyword(s):

Risk Factors ◽

Heart Transplantation ◽

Graft Failure ◽

Primary Graft Failure

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Risk Factors for Survival After Heart Transplantation in Children and Young Adults: A 22-Year Study of 179 Transplants

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118782190 ◽

2018 ◽

Vol 9 (5) ◽

pp. 557-564 ◽

Cited By ~ 3

Author(s):

Shawn Shah ◽

Alfred Asante-Korang ◽

Sharon R. Ghazarian ◽

Gary Stapleton ◽

Carrie Herbert ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Heart Transplantation ◽

Mechanical Circulatory Support ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Circulatory Support ◽

Kaplan Meier ◽

Diagnostic Characteristics

Background: This article reviews all patients who underwent heart transplantation (HTx) within a single institution (172 patients underwent 179 HTx [167 first-time HTxs, 10 second HTxs, 2 third HTxs]) to describe diagnostic characteristics, management protocols, and risk factors for mortality. Methods: Descriptive analysis was performed for the entire cohort using mean, standard deviation, median, interquartile range, and overall range, as appropriate. Univariable and multivariable Cox proportional hazards models were performed to identify prognostic factors for outcomes over time. The primary outcome of interest was mortality, which was modeled by Kaplan-Meier analysis. Results: Median age at HTx was 263 days (range, 5 days to 24 years; mean = 4.63 ± 5.95 years; 18 neonates, 79 infants). Median weight at HTx was 7.5 kg (range, 2.2-113 kg; mean = 19.36 ± 23.54). Diagnostic categories were cardiomyopathy (n = 62), primary transplantation for hypoplastic left heart syndrome (HLHS) or HLHS-related malformation (n = 33), transplantation after cardiac surgery for HLHS or HLHS-related malformation (n = 17), non-HLHS congenital heart disease (n = 55), and retransplant (n = 12). Operative mortality was 10.1% (18 patients). Cumulative total follow-up is 1,355 years. Late mortality was 18.4% (33 patients). Overall Kaplan-Meier five-year survival was 76.2%. One hundred twenty-one patients are alive with a mean follow-up of 7.61 ± 6.46 years. No survival differences were seen among the five diagnostic subgroups ( P = .064) or between immunosensitized patients (n = 31) and nonimmunosensitized patients (n = 141; P = .422). Conclusions: Excellent results are expected for children undergoing HTx with comparable results among diagnostic groups. Pretransplant mechanical circulatory support and posttransplant mechanical circulatory support are risk factors for decreased survival. Survival after transplantation for HLHS or HLHS-related malformation is better with primary HTx in comparison to HTx after prior cardiac surgery.

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