Elucidating Clinical Factors Implicated in Primary Graft Dysfunction After Heart Transplantation.
Advanced Heart Failure, University of Texas Medical School at Houston, Houston, TX.
Meeting: 2016 American Transplant Congress
Abstract number: B150
Keywords: Donors, Graft function, Heart failure, Heart transplant patients, unrelated
Session Information
Session Name: Poster Session B: Hearts and VADs in Depth - The Force Awakens
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Primary graft dysfunction (PGD) is a frequent complication after heart transplantation (HT) and remains among the leading causes of mortality in these patients. We aim to identify factors implicated in the development of PGD, thus shedding light on possible preventive strategies.
Methods:Retrospective review of 99 patients who underwent HT between 2012 and 2015. 18 patients developed PGD. Donor and surgical procedure characteristics were studied in PGD patients and compared with patients without PGD.
|
Donor |
|||
|
|
No PGD |
PGD |
P-value |
|
DM |
3% |
2% |
0.219 |
|
HTN |
10.1% |
3% |
0.699 |
|
CPR |
25.3% |
8.1% |
0.277 |
|
Downtime <10 min |
67.7% |
11.1% |
0.55 |
|
Downtime >10 min |
14.1% |
7.1% |
|
|
TBDACC <3 days |
28.3% |
14.1% |
0.0011 |
|
TBDACC >3 days |
54.5% |
3% |
|
|
Cocaine |
4% |
2% |
1 |
|
Amphetamines |
8.1% |
4% |
0.221 |
|
Opioids |
8.1% |
5.1% |
0.049 |
|
Mean Inotropic Score |
16.8 |
11.7 |
0.254 |
|
Troponin I <1 |
60.1% |
10.1% |
0.384 |
|
Troponin I >1 |
22.2% |
7.1% |
|
|
LVEF >50 |
69.7% |
17.2% |
0.294 |
|
Anoxia |
13.1% |
8.1% |
0.021 |
|
Traumatic Brain Injury |
23.2% |
2% |
0.227 |
|
Intracerebral hemorrhage |
16.1% |
6.1% |
0.217 |
|
Surgical Procedure |
|||
|
CMV Status R-/D- |
16.7% |
4% |
0.751 |
|
R-/D+ |
18.2 % |
1% |
0.477 |
|
R+/D- |
12.1% |
4% |
0.183 |
|
R+/D+ |
35.4% |
9.1% |
0.613 |
|
Ischemic time <2 hr |
13.1% |
2% |
0.9 |
|
2-4 hr |
59.6% |
13.1% |
|
|
>4 hr |
9.1% |
3% |
|
|
Blood type AB/A |
0 |
2 |
0.031 |
|
PRBCs transfusions >10 |
12.1% |
3% |
0.731 |
Results:In univariate analysis, opioid use (p=0.049), death due to anoxia (p=0.021) and receptor/donor blood type match AB/A were associated with PGD (p=0.031). Time from brain death to aortic cross clamp (TBDACC) ≥3 days was found protective from PGD development (p=0.0011). Multivariate analysis confirmed patients with a TBDACC ≥3 days had lower odds of developing PGD [OR=0.098 (95%CI=0.021-0.443), p=0.0026].
We found that a TBDACC ≥3 days was a significant protective factor for PGD. Prior studies suggest brain death triggers a catecholamine surge that increases the myocardiocytes susceptibility to injury. We hypothesize that if longer time elapses after brain death, adaptive tissue mechanisms take place to blunt this pathologic response, thus decreasing the likelihood of PGD.
CITATION INFORMATION: Quintana-Quezada R, Rajapreyar I, Yeh Y, Choi S, Gregoric I, Loyalka P, Kar B. Elucidating Clinical Factors Implicated in Primary Graft Dysfunction After Heart Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Quintana-Quezada R, Rajapreyar I, Yeh Y, Choi S, Gregoric I, Loyalka P, Kar B. Elucidating Clinical Factors Implicated in Primary Graft Dysfunction After Heart Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/elucidating-clinical-factors-implicated-in-primary-graft-dysfunction-after-heart-transplantation/. Accessed December 1, 2023.« Back to 2016 American Transplant Congress