Heart transplants fail suddenly in 1 in 10 patients, doubling mortality risk
A 37-year study of 667 heart transplant recipients identified primary graft dysfunction in 10.5% of cases, with affected patients facing 45% mortality within 30 days versus 3% for others. The finding highlights a critical gap in transplant selection criteria—surprisingly, donor factors didn't predict failure, suggesting hospitals need better tools to identify at-risk recipients and improve perioperative protocols.
Originaltitel: Incidence, predictors and outcomes following primary graft dysfunction after cardiac transplantation.
Primär transplantathaveri (PGD) skapar kritiska val vid hjärttransplantation — en svenskstudie från Sahlgrenska visar att 10,5 procent av mottagarna drabbas, med dödlighet på 45 procent inom 30 dagar jämfört med 3 procent utan PGD. Forskare analyserade 667 vuxna hjärttransplantationer mellan 1984 och 2021. Mottagarfaktorer och längre tid på hjärt-lungmaskin ökade risken för PGD; donatorfaktorer var inte associerade. Patienter med PGD behövde förlängd mekanisk ventilering, utökad IVA-vård, mekaniskt cirkulatoriskt stöd och dialys. För inköpschefer och regionledning motsvarar detta ökade resursbehov — IVA-tid, blodprodukter, mechanisk hjälp. För regulatoriska specialister blir mottagarselektering och preoperativ optimering centralt. Studiens omfattning (38 års data) gör den vägledande för nordiska transplantationsprogram när risker och eftervård planeras.
Primary graft dysfunction (PGD) is the leading cause of early morbidity and mortality after heart transplantation (HTx). We retrospectively analyzed 830 consecutive HTx performed between 1984 and 2021. After excluding patients <18 years and those with missing data, 667 adult recipients remained. ISHLT PGD criteria were applied and perioperative variables and outcomes were reviewed. PGD occurred in 70 patients (10.5%), including 41 (6.1%) with left ventricular PGD and 29 (4.3%) with right ventricular PGD. Most LV-PGD cases were severe (88%). Patients with PGD were younger and more frequently had pretransplant dialysis, ventricular assist device support, or prior cardiac surgery. No donor-related factors were associated with PGD. Recipient-related factors and longer cardiopulmonary bypass time were associated with increased risk. PGD was associated with prolonged mechanical ventilation and ICU stay, and increased need for mechanical circulatory support, dialysis, reoperation, and treatment for sepsis. Mortality or re-transplantation was significantly higher in PGD patients at 30 days (45% vs. 3%) and 1 year (51% vs. 8%; HR 6.89, 95% CI 4.01-11.83, p < 0.0001).