TY - JOUR
T1 - Report from a consensus conference on primary graft dysfunction after cardiac transplantation
AU - Kobashigawa, Jon
AU - Zuckermann, Andreas
AU - Macdonald, Peter
AU - Leprince, Pascal
AU - Esmailian, Fardad
AU - Luu, Minh
AU - Mancini, Donna
AU - Patel, Jignesh
AU - Razi, Rabia
AU - Reichenspurner, Hermann
AU - Russell, Stuart
AU - Segovia, Javier
AU - Smedira, Nicolas
AU - Stehlik, Josef
AU - Wagner, Florian
N1 - Funding Information:
Jon Kobashigawa, MD, is scientific medical advisor to TransMedics Inc and Novartis, and discloses research grants and research support from Novartis and XDx Inc. Fardad Esmailian, MD, is a member of steering committee for PROCEED II trial. Jignesh Patel, MD, PhD, discloses research grants from Alexion Pharmaceuticals. None of the other authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
Funding Information:
This conference was jointly funded by the ISHLT and the Cedars-Sinai Heart Institute.
PY - 2014/4
Y1 - 2014/4
N2 - 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.
AB - 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.
KW - cardiac transplantation
KW - consensus
KW - outcomes
KW - primary graft dysfunction
KW - primary graft failure
UR - http://www.scopus.com/inward/record.url?scp=84896988679&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2014.02.027
DO - 10.1016/j.healun.2014.02.027
M3 - Editorial
C2 - 24661451
AN - SCOPUS:84896988679
SN - 1053-2498
VL - 33
SP - 327
EP - 340
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 4
ER -