Background: Primary graft dysfunction (PGD) and failure (PGF) are severe complications after heart transplantation. Until now there are no common guidelines to differentiate between these complications. In this single center analysis, the impact of both PGD and PGF on outcome after transplantation was analyzed.

Methods: We investigated 1238 patients after heart transplantation between 1984-2011. PGD was defined as high inotropic support to wean a patient from bypass after transplantation. PGF was defined as need for mechanical support. Incidence, outcome and causes of death in both groups were compared during different time periods (A:1984-1999, B: 2000-2011). Survival was compared by Kaplan-Meier analysis. A p-value of <0.05 was defined as significant.

Results: Overall incidence of primary Graft problems was 15.4%. 116 patients developed PGD (9.3%) and 76 patients showed PGF (6.1%). Incidence of PGD and PGF changed significantly over time (PGD: A: 10%, B: 8.4%,; p<0.001; PGF: A: 3.6%,B: 9.1%; p<0.001). 30 day as well a 1-year survival was higher in the PGD group (30d: PGD: 65% vs. PGF: 51.4%: p=0.091; 1-year: PGD: 58.3% vs. PGF: 34.7%: p=0.004). 30-day survival with PGD did not change over time (A: 61.5%, B: 75.9%, P=n.s.), whereas it increased significantly in the PGF group (A: 23.8%, B: 62.7%, P<0.001). 1-year survival increased in both groups (PGD: A:53.8%, B: 72.4%; p=0075; PGF: A: 23.8%, B: 39.2%, p=0.015).

Conclusions: Survival of patients with PGD and PGF is significantly reduced. In recent time eras survival haa increased. International guidelines for prevention and treatment of these complications are needed.

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