Predicted Heart Mass Difference as a Risk Factor for Severe Primary Graft Dysfunction in the Contemporary Era of Heart Transplantation: A Report from the International Consortium on Primary Graft Dysfunction

F. Foroutan¹, L. K. Truby², Y. Moayedi¹, J. Han³, J. Guzman⁴, M. Farrero⁴, E. Baughan⁵, M. Farr⁵, H. Zafar⁶, J. Felius⁶, J. van Zyl⁷, D. Law⁸, S. Chih⁸, P. Angleitner⁹, M. Sabatino¹⁰, A. DeVore², R. J. Miller¹¹, L. Potena¹⁰, A. Zuckermann⁹, K. K. Khush³, S. A. Hall⁶, H. J. Ross¹

¹Ted Rogers Centre for Heart Research, Toronto, ON, Canada, ²Duke University School of Medicine, Durham, NC, ³Stanford University, Stanford, CA, ⁴Clinic Barcelona Hospital Universitari, Barcelona, Spain, ⁵Columbia University Medical Center, New York, NY, ⁶Baylor University Medical Center, Dallas, TX, ⁷Dallas University Medical Center, Dallas, TX, ⁸University of Ottawa Heart Institute, Ottawa, ON, Canada, ⁹Medical University of Vienna, Vienna, Austria, ¹⁰Bologna University Hospital, Bologna, Italy, ¹¹University of Calgary, Calgary, AB, Canada

Meeting: 2021 American Transplant Congress

Abstract number: LB 23

Keywords: Graft function, Heart, Risk factors

Topic: Clinical Science » Heart » Heart and VADs: All Topics

Session Information

Session Name: Late Breaking: All Organs

Session Type: Rapid Fire Oral Abstract

Date: Tuesday, June 8, 2021

Session Time: 6:00pm-7:00pm

Presentation Time: 6:30pm-6:35pm

Location: Virtual

*Purpose: Primary Graft Dysfunction (PGD) increases early mortality after heart transplant (HT). Predicted heart mass (PHM) difference may be a risk factor for PGD. Lack of granular data in registries limited our ability to validate its role in risk stratification for PGD. We used our recently developed International Consortium on PGD to evaluate PHM difference as a risk factor for PGD.

*Methods: Total of 10 centers from Europe, US, and Canada provided data. Using the 2014 ISHLT definition, we identified cases of severe PGD. We calculated PHM for the left (LV) and right ventricle (RV) using the Multi-Ethnic Study of Atherosclerosis (MESA) equations. We calculated the %PHM difference between donors and recipients to investigate the association between PHM difference and severe PGD using a logistic regression model, adjusted for ischemic time and pre-HT LVAD.

*Results: Between 2010 to 2020, we included 2,510 recipients, 634 females (25%), mean age of 53.9 ± 12.4 years. 8.4% were supported by IABP, 1.3% on ECMO, and 35% on LVAD pre-HT. Most donors were male (64.3%) with mean age of 36.5±13.0 years and ischemic time of 3.4±1.1 hours. A total of 196 recipients had severe PGD. Donor and recipient hearts were well-matched with a median total PHM difference of 2.1% (IQR -9.7 to 14.4%). The donor RV was typically oversized with a RV PHM difference of 12.7% (IQR 1.4 to 22.5%) and the LV slightly undersized with difference of -3.8% (IQR -16.6 to 9.9%). For every 10% increase in LV undersizing, there was a 16% increase in the odds of severe PGD. We observed no significant association between RV PHM difference and severe PGD.

*Conclusions: Our International Consortium on PGD suggests under-sizing of the LV increases the risk of PGD. Future risk prediction models should integrate LV PHM difference as a risk factor for PGD.

Multivariable Logistic Regression Model for Severe Primary Graft Dysfunction
	OR	95% CI
LV PHM Difference	1.16	1.02 – 1.32
RV PHM Difference	0.98	0.83 – 1.15

To cite this abstract in AMA style:

Foroutan F, Truby LK, Moayedi Y, Han J, Guzman J, Farrero M, Baughan E, Farr M, Zafar H, Felius J, Zyl Jvan, Law D, Chih S, Angleitner P, Sabatino M, DeVore A, Miller RJ, Potena L, Zuckermann A, Khush KK, Hall SA, Ross HJ. Predicted Heart Mass Difference as a Risk Factor for Severe Primary Graft Dysfunction in the Contemporary Era of Heart Transplantation: A Report from the International Consortium on Primary Graft Dysfunction [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/predicted-heart-mass-difference-as-a-risk-factor-for-severe-primary-graft-dysfunction-in-the-contemporary-era-of-heart-transplantation-a-report-from-the-international-consortium-on-primary-graft-dysf/. Accessed May 17, 2025.

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