Severe primary graft failure: Are there lasting impacts? Analysis from the PHTS Database
Background: Primary graft failure (PGF) is a leading cause of early morbidity and mortality after heart transplantation (HTx). PGF is secondary to graft ischemia and ischemia-reperfusion injuries to the cardiomyocytes and vasculature of the donor heart after transplantation. Longer-term outcomes aft...
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Elsevier
2025-02-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133424001332 |
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| author | Jennifer Conway, MD Tara Pidborochynski, MSc James K. Kirklin, MD Ryan Cantor, PhD Hong Zhao, PhD Aryaz Sheybani, MD Jacqueline Lamour, MD Lakshmi Gokanapudy Hahn, MD Leslie Collins, MD Jessica Laks, MD Darren H. Freed, MD, PhD |
| author_facet | Jennifer Conway, MD Tara Pidborochynski, MSc James K. Kirklin, MD Ryan Cantor, PhD Hong Zhao, PhD Aryaz Sheybani, MD Jacqueline Lamour, MD Lakshmi Gokanapudy Hahn, MD Leslie Collins, MD Jessica Laks, MD Darren H. Freed, MD, PhD |
| author_sort | Jennifer Conway, MD |
| collection | DOAJ |
| description | Background: Primary graft failure (PGF) is a leading cause of early morbidity and mortality after heart transplantation (HTx). PGF is secondary to graft ischemia and ischemia-reperfusion injuries to the cardiomyocytes and vasculature of the donor heart after transplantation. Longer-term outcomes after PGF are not well studied. Methods: Patients with an HTx (January 1, 2010 to June 30, 2022) were identified using the Pediatric Heart Transplant Society registry. PGF was defined as death, retransplantation, or need for mechanical circulatory support within 72 hours of HTx. Kaplan-Meier analysis and Cox proportional hazard modeling were utilized. Results: Of the 4,982 patients with a primary HTx, 5.4% (n = 269) met criteria for PGF. Patients with PGF were younger, with higher proportion of congenital heart disease, longer cardiopulmonary bypass and ischemic times (IT), and more likely to be on extracorporeal membrane oxygenation or ventilator at HTx (all p < 0.0001, IT p = 0.0006). PGF resulted in lower overall survival (1 year: 54% vs 94%, p < 0.001). This remained true when conditional survival was examined at 30 and 90 days but not at 1 year (p = 0.1143). Freedom from rejection did not differ between the groups at overall or conditional on 30 days but was slightly higher for those with PGF at 90 and 365 days. There was no difference in freedom from coronary allograft vasculopathy (CAV). PGF was an independent predictor of overall graft loss (hazard ratios [HR] 4.7, p < 0.0001) and conditional survival to 30 days (HR 2.47, p < 0.0001) and 90 days (HR 1.6, p = 0.012) but not beyond 1 year. Conclusions: Severe PGF is an independent predictor of early mortality post-HTx but subsequently does not further impact long-term survival, overall risk of rejection, or CAV. Understanding the impact of milder forms of PGF on survival and long-term outcomes is still needed. Methods to decrease the risk of PGF, such as alternative preservation and storage techniques, may impact early mortality post-HTx. |
| format | Article |
| id | doaj-art-026bd82a8a4949499c3d268673ef0e57 |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
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| series | JHLT Open |
| spelling | doaj-art-026bd82a8a4949499c3d268673ef0e572025-02-09T05:01:57ZengElsevierJHLT Open2950-13342025-02-017100184Severe primary graft failure: Are there lasting impacts? Analysis from the PHTS DatabaseJennifer Conway, MD0Tara Pidborochynski, MSc1James K. Kirklin, MD2Ryan Cantor, PhD3Hong Zhao, PhD4Aryaz Sheybani, MD5Jacqueline Lamour, MD6Lakshmi Gokanapudy Hahn, MD7Leslie Collins, MD8Jessica Laks, MD9Darren H. Freed, MD, PhD10Stollery Children's Hospital, Edmonton, Alberta, Canada; Corresponding author: Jennifer Conway, MD, Stollery Children’s Hospital, 8440 112 Street, Edmonton, AB T6G4C2, Canada.Department of Pediatrics, University of Alberta, Edmonton, Alberta, CanadaKirklin Solutions, Hoover, AlabamaKirklin Solutions, Hoover, AlabamaKirklin Solutions, Hoover, AlabamaNemours Children's Hospital, Wilmington, DelawareMount Sinai Medical Center, New York, New YorkWashington University in St. Louis, St. Louis, MissouriUniversity of Alabama at Birmingham, Birmingham, AlabamaJohns Hopkins All Children's Hospital, St. Petersburg, FloridaDepartment of Cardiac Surgery, University of Alberta, Edmonton, Alberta, CanadaBackground: Primary graft failure (PGF) is a leading cause of early morbidity and mortality after heart transplantation (HTx). PGF is secondary to graft ischemia and ischemia-reperfusion injuries to the cardiomyocytes and vasculature of the donor heart after transplantation. Longer-term outcomes after PGF are not well studied. Methods: Patients with an HTx (January 1, 2010 to June 30, 2022) were identified using the Pediatric Heart Transplant Society registry. PGF was defined as death, retransplantation, or need for mechanical circulatory support within 72 hours of HTx. Kaplan-Meier analysis and Cox proportional hazard modeling were utilized. Results: Of the 4,982 patients with a primary HTx, 5.4% (n = 269) met criteria for PGF. Patients with PGF were younger, with higher proportion of congenital heart disease, longer cardiopulmonary bypass and ischemic times (IT), and more likely to be on extracorporeal membrane oxygenation or ventilator at HTx (all p < 0.0001, IT p = 0.0006). PGF resulted in lower overall survival (1 year: 54% vs 94%, p < 0.001). This remained true when conditional survival was examined at 30 and 90 days but not at 1 year (p = 0.1143). Freedom from rejection did not differ between the groups at overall or conditional on 30 days but was slightly higher for those with PGF at 90 and 365 days. There was no difference in freedom from coronary allograft vasculopathy (CAV). PGF was an independent predictor of overall graft loss (hazard ratios [HR] 4.7, p < 0.0001) and conditional survival to 30 days (HR 2.47, p < 0.0001) and 90 days (HR 1.6, p = 0.012) but not beyond 1 year. Conclusions: Severe PGF is an independent predictor of early mortality post-HTx but subsequently does not further impact long-term survival, overall risk of rejection, or CAV. Understanding the impact of milder forms of PGF on survival and long-term outcomes is still needed. Methods to decrease the risk of PGF, such as alternative preservation and storage techniques, may impact early mortality post-HTx.http://www.sciencedirect.com/science/article/pii/S2950133424001332primary graft failurepediatricssurvivalrejectionallograft vasculopathy |
| spellingShingle | Jennifer Conway, MD Tara Pidborochynski, MSc James K. Kirklin, MD Ryan Cantor, PhD Hong Zhao, PhD Aryaz Sheybani, MD Jacqueline Lamour, MD Lakshmi Gokanapudy Hahn, MD Leslie Collins, MD Jessica Laks, MD Darren H. Freed, MD, PhD Severe primary graft failure: Are there lasting impacts? Analysis from the PHTS Database JHLT Open primary graft failure pediatrics survival rejection allograft vasculopathy |
| title | Severe primary graft failure: Are there lasting impacts? Analysis from the PHTS Database |
| title_full | Severe primary graft failure: Are there lasting impacts? Analysis from the PHTS Database |
| title_fullStr | Severe primary graft failure: Are there lasting impacts? Analysis from the PHTS Database |
| title_full_unstemmed | Severe primary graft failure: Are there lasting impacts? Analysis from the PHTS Database |
| title_short | Severe primary graft failure: Are there lasting impacts? Analysis from the PHTS Database |
| title_sort | severe primary graft failure are there lasting impacts analysis from the phts database |
| topic | primary graft failure pediatrics survival rejection allograft vasculopathy |
| url | http://www.sciencedirect.com/science/article/pii/S2950133424001332 |
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