Featured articleRADIAL: A novel primary graft failure risk score in heart transplantation
Section snippets
Patient population
A series of 696 consecutive HTs were performed at our hospital between 1984 and 2006. Data were collected prospectively into a database at the time of HT and then retrospectively reviewed for this study. We excluded 23 patients with a second transplant and 30 patients with transplantation of another organ in combination with HT. We also excluded 22 patients with unusually high pulmonary hypertension before HT (defined by the presence of pulmonary artery systolic pressure >50 mm Hg,
Population data
The main recipient, donor and procedural characteristics are shown in Table 1. PGF, according to our definition, occurred in 56 of 621 HTs (overall incidence 9%). Isolated RV failure occurred in 34 patients (61%), and left (11%) or biventricular (28%) dysfunction was observed in 22 patients (39%).
In addition to intravenous inotropic therapy, 37 HT recipients (66%) received mechanical support. In 27 PGF patients (48%) a VAD was implanted (20 right-sided, 1 left-sided and 6 biventricular
Discussion
PGF is a major cause of death after HT, and is probably the most frustrating for clinicians. Even if PGF is not always the final cause of death in these patients, it often contributes to complications, such prolonged ventilation and ICU stay, which are related to higher mortality rates. Nevertheless, PGF has received little attention in the HT literature. In the 2009 report of the ISHLT registry, PGF was shown to be the main cause of early mortality, accounting for 40% of deaths within 30 days.1
Disclosure statement
This work was supported by the Fundación para la Investigación Biomédica del Hospital Universitario Puerta de Hierro, Red de Investigación Clínica y Básica en Insuficiencia Cardiaca (REDINSCOR) and Beca de Investigación en Trasplante Cardiaco de la Sección de Insuficiencia Cardiaca y Trasplante of the Spanish Society of Cardiology.
The authors have no conflicts of interest to disclose.
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