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

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

AU - Consensus Conference participants

N1 - Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

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 - Cooperative Behavior

KW - Graft Rejection/diagnosis

KW - Heart Transplantation/mortality

KW - Humans

KW - Interdisciplinary Communication

KW - Ischemic Preconditioning, Myocardial

KW - Myocardial Reperfusion Injury/diagnosis

KW - Postoperative Complications/diagnosis

KW - Primary Graft Dysfunction/diagnosis

KW - Reoperation

KW - Risk Factors

KW - Survival Analysis

U2 - 10.1016/j.healun.2014.02.027

DO - 10.1016/j.healun.2014.02.027

M3 - SCORING: Journal article

C2 - 24661451

VL - 33

SP - 327

EP - 340

JO - J HEART LUNG TRANSPL

JF - J HEART LUNG TRANSPL

SN - 1053-2498

IS - 4

ER -