Report from a consensus conference on primary graft dysfunction after cardiac transplantation

Jon Kobashigawa, Andreas Zuckermann, Peter Macdonald, Pascal Leprince, Fardad Esmailian, Minh Luu, Donna Mancini, Jignesh Patel, Rabia Razi, Hermann Reichenspurner, Stuart Russell, Javier Segovia, Nicolas Smedira, Josef Stehlik, Florian Wagner

Research output: Contribution to journalEditorial

544 Scopus citations

Abstract

Although primary graft dysfunction (PGD) is fairly common early after cardiac transplant, standardized schemes for diagnosis and treatment remain contentious. Most major cardiac transplant centers use different definitions and parameters of cardiac function. Thus, there is difficulty comparing published reports and no agreed protocol for management. A consensus conference was organized to better define, diagnose, and manage PGD. There were 71 participants (transplant cardiologists, surgeons, immunologists and pathologists), with vast clinical and published experience in PGD, representing 42 heart transplant centers worldwide. State-of-the-art PGD presentations occurred with subsequent breakout sessions planned in an attempt to reach consensus on various issues. Graft dysfunction will be classified into primary graft dysfunction (PGD) or secondary graft dysfunction where there is a discernible cause such as hyperacute rejection, pulmonary hypertension, or surgical complications. PGD must be diagnosed within 24 hours of completion of surgery. PGD is divided into PGD-left ventricle and PGD-right ventricle. PGD-left ventricle is categorized into mild, moderate, or severe grades depending on the level of cardiac function and the extent of inotrope and mechanical support required. Agreed risk factors for PGD include donor, recipient, and surgical procedural factors. Recommended management involves minimization of risk factors, gradual increase of inotropes, and use of mechanical circulatory support as needed. Retransplantation may be indicated if risk factors are minimal. With a standardized definition of PGD, there will be more consistent recognition of this phenomenon and treatment modalities will be more comparable. This should lead to better understanding of PGD and prevention/minimization of its adverse outcomes.

Original languageEnglish
Pages (from-to)327-340
Number of pages14
JournalJournal of Heart and Lung Transplantation
Volume33
Issue number4
DOIs
StatePublished - Apr 2014
Externally publishedYes

Keywords

  • cardiac transplantation
  • consensus
  • outcomes
  • primary graft dysfunction
  • primary graft failure

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