Details

Autor(en) / Beteiligte

• Cosío Carmena, M. Dolores G., MD, PhD
• Gómez Bueno, Manuel, MD
• Almenar, Luis, MD
• Delgado, Juan F., MD, PhD
• Arizón, Jose M., MD
• González Vilchez, Francisco, MD
• Crespo-Leiro, Maria G., MD, PhD
• Mirabet, Sonia, MD
• Roig, Eulalia, MD, PhD
• Pérez Villa, Félix, MD, PhD
• Fernández-Yañez, Juan F., MD
• Lambert, Jose L., MD
• Manito, Nicolás, MD
• Fuente, Luis, MD
• Sanz Julve, Maria L., MD
• Pascual, Domingo, MD
• Rábago, Gregorio, MD
• Millán, Isabel, MD
• Alonso-Pulpón, Luis A., MD, PhD
• Segovia, Javier, MD, PhD

Titel

Primary graft failure after heart transplantation: Characteristics in a contemporary cohort and performance of the RADIAL risk score

Ist Teil von

• The Journal of heart and lung transplantation, 2013-12, Vol.32 (12), p.1187-1195

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2013

Quelle

ScienceDirect

Beschreibungen/Notizen

• Background Primary graft failure (PGF) is the leading cause of early heart transplantation (HT) mortality. Our aim was to analyze PGF currently and explore the ability of a dedicated score for PGF risk stratification. Methods After applying a dedicated PGF definition, we analyzed its incidence, mortality, and associated factors in a multicenter cohort of 857 HTs performed in 2006 to 2009. We used the following criteria: recipient right (R) atrial pressure ≥ 10 mm Hg; age (A) ≥ 60 years; diabetes (D) mellitus, and inotrope (I) dependence; donor age (A) ≥ 30 years, and length (L) of ischemia ≥ 240 minutes to calculate the RADIAL score for PGF risk prediction. Results PGF incidence was 22%. The right ventricle was almost always affected, alone (45%) or as part of biventricular failure (47%). Mechanical circulatory support was used in 55%. Mortality attributable to PGF was 53% and extended through the third month after HT, but thereafter, PGF had little influence in long-term outcome. The RADIAL score was higher in PGF patients (2.78 ± 1.1 vs 2.42 ± 1.1, p = 0.001) and stratified 3 groups with incremental PGF incidence: low risk (12.1%), intermediate risk (19.4%), and high risk (27.5%, p = 0.001). Conclusions PGF had a strong impact, with an incidence of 22% and a mortality exceeding 50% that extends through the third post-HT month. The RADIAL score classified patients into 3 groups with incremental risk for PGF and may be useful for its prevention and early therapy.