Determinants of early graft failure following cardiac transplantation, a 10-year, multi-institutional, multivariable analysis

Abstract OBJECTIVES A heart transplant (Htx) remains the gold standard treatment for patients with advanced heart failure. Considering the limited availability of organs, donor risk scores might improve organ selection and allocation. The objective of the study was to compare United Network for Organ Sharing, RADIAL and Eurotransplant scoring models in calculating post-Htx outcomes in an Italian Htx population. METHODS Between January 2000 and December 2017, a total of 461 adult patients underwent Htxs. United Network for Organ Sharing, RADIAL and Eurotransplant scores were calculated. Clinical features and donor risk scores were tested to identify preoperative, intraoperative and postoperative risk variables and eventually validate the scores on our population. RESULTS Early graft failure was detected in 16.1% (74/461). Post-Htx extracorporeal life support was used in 11.1% (51/461). Of the donor-related factors, the use of noradrenaline (P = 0.015) negatively influenced early outcomes, whereas an ischaemic time >240 min (P = 0.037) influenced early graft failure occurrence. The Eurotransplant donor score did not impact outcomes; the RADIAL score significantly influenced both early and late mortality; and the United Network for Organ Sharing score influenced only late mortality. On the multivariable analysis, after adjustment of scores per cohort, noradrenaline infusion was the main independent predictor of in-hospital mortality for the donors, whereas age of the recipient [odds ratio (OR) 1.003, 1.003–1.081; P = 0.032] and use of preoperative extracorporeal membrane oxygenation (OR 3.320, 1.124–9.805; P = 0.030) were the main independent predictors for the recipients. CONCLUSIONS None of the validated donor scoring systems fully behave as reliable predictors of transplant outcomes. According to our ‘local only’ graft selection, specific donor and recipient risk variables should be monitored in order to predict early and late outcomes satisfactorily.

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Extra-corporeal membrane oxygenation temporary support for early graft failure after cardiac transplantation☆

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2009.05.034 ◽

2009 ◽

Cited By ~ 7

Author(s):

Cosimo D’Alessandro ◽

Stéphane Aubert ◽

Jean Louis Golmard ◽

Beltran Levy Praschker ◽

Charles Edouard Luyt ◽

...

Keyword(s):

Graft Failure ◽

Cardiac Transplantation ◽

Extra Corporeal Membrane Oxygenation ◽

Membrane Oxygenation ◽

Temporary Support ◽

Early Graft ◽

Early Graft Failure

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Rebubbling and graft failure in Descemet membrane endothelial keratoplasty: a prospective Dutch registry study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317041 ◽

2021 ◽

pp. bjophthalmol-2020-317041

Author(s):

Suryan Dunker ◽

Bjorn Winkens ◽

Frank van den Biggelaar ◽

Rudy Nuijts ◽

Pieter Jan Kruit ◽

...

Keyword(s):

Risk Factors ◽

Endothelial Cell ◽

Graft Failure ◽

Surgical Complication ◽

Multivariable Analysis ◽

Registry Study ◽

Recipient Age ◽

Early Graft ◽

Independent Risk Factors ◽

Early Graft Failure

AimsTo identify risk factors for rebubbling, and early graft failure after Descemet membrane endothelial keratoplasty (DMEK).MethodsIn this prospective registry study, all consecutive DMEK procedures registered in the Netherlands Organ Transplant Registry were assessed (n=752). Univariable and multivariable analysis was performed using logistic regression. The effect of rebubbling on endothelial cell density was analysed using a linear mixed model.Results144 of 752 (19%) eyes underwent rebubbling. Rebubbling was successful in 101 eyes (70%). In eyes that underwent rebubbling, the graft failure rate was significantly higher than eyes that did not undergo rebubbling (30% vs 9%, respectively; OR: 4.28, 95% CI 2.72 to 6.73, p<0.001). In multivariable analysis, independent risk factors for rebubbling were surgical complication (OR: 2.28, 95% CI 1.20 to 4.33, p=0.012) and older recipient age (OR: 1.04 (per increase of 1 year), 95% CI 1.01 to 1.07, p=0.003). Risk factors for developing graft failure within 3 months were transplant before 2016 (OR: 3.32, 95% CI 1.87 to 5.90, p<0.001), and surgical complication (OR: 2.93, 95% CI 1.42 to 6.04, p=0.004). Throughout the study period, rebubbling and early graft failure were inversely related. Eyes that underwent rebubbling showed significantly lower endothelial cell densities at 3, 6 and 12 months compared with eyes that did not undergo rebubbling (all p<0.001).ConclusionsThis Dutch registry study identified independent risk factors for DMEK graft detachment leading to rebubbling, namely recipient age and surgical complication, and early graft failure, namely transplantation before 2016 and surgical complication. Rebubbling was associated with significantly higher endothelial cell loss in the first year after surgery.

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Platelet Adhesion in Polytetrafluoroethylene (PTFE) Vascular Grafts In Vivo and the Influence of Increased Intramuscular Pressure-An Experimental Model

Thrombosis and Haemostasis ◽

10.1055/s-0038-1665334 ◽

1983 ◽

Vol 50 (04) ◽

pp. 881-884 ◽

Cited By ~ 3

Author(s):

J T Christenson ◽

P Qvarfordt ◽

S-E Strand ◽

D Arvidsson ◽

T Sjöberg ◽

...

Keyword(s):

Blood Flow ◽

Graft Failure ◽

Small Diameter ◽

Graft Material ◽

Intramuscular Pressure ◽

Initial Flow ◽

Early Graft ◽

Wick Technique ◽

Early Graft Failure

SummaryThrombogenicity of graft material is involved in early graft failure in small diameter grafts. The frequently seen postoperative swelling of the leg after distal revascularization may cause an increased intramuscular pressure and early graft failure.Pairs of 4 mm polytetrafluoroethylene (PTFE) grafts were implanted. Autologous platelets were labeled with mIn-oxine. Platelet adhesiveness onto the grafts were analyzed from gamma camera images. Intramuscular pressures were measured with wick technique. Blood flow was measured. One graft served as control the other as test graft. Ninety minutes after declamping the i. m. pressure was increased in the test-leg to 30 mmHg, and later to 60 mmHg.In the control-graft platelet uptake increased to a maximum 60 min after declamping. Blood flow and i.m. pressure remained uneffected. The test-grafts were initially similar but when i.m. pressure was increased to 30 mmHg activity in the grafts increased significantly. Blood flow decreased with 12% of initial flow. When i. m. pressure was raised to 60 mmHg platelet uptake continued to increase.An increased intramuscular pressure of 30 mmHg or more significantly increase the amount of platelets adhering onto PTFE grafts, emphasizing the need for measuring intramuscular pressures after lower limb vascular revascularizations.

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