Título

Primary graft failure after cardiac transplantation: prevalence, prognosis and risk factors

Introdução

Primary graft failure is a common and devastating complication that has leveraged its prevalence, despite the advances in perioperative treatment. To evaluate the prevalence of PGF in a single institution and its impact on survival. To explore associated risk factors.

Material e Método

From Nov-2003 through Dez-2015, 304 patients were submitted to cardiac transplantation and were classified after exclusion criteria into a non-PGF group 243(84%) and a PGF group 47(16%). Recipients’ characteristics were similar regarding age (54.6±10.6vs.54±9.4years;P=0.741), male sex (78.2%vs.72.3%;P=0.381), transpulmonary gradient (9.4±4.2vs.10.5±5.6 mmHg; P=0.149), and comorbities such as diabetes, arterial hypertension or vascular arteriopathy. In the non-PGF group, ischemic (41.2% vs. 29.8%; P=0.144). Donors to the PGF group had similar age (35.5±11.4 vs. 37.5±10.7years; P=0.267) but were predominantly female (21%vs.42.6%; P=0.002).

Resultados

Mean total ischemic (89±36.8vs.103±44.7min;P=0.019) and cardiopulmonary bypass (92.8±14.5 vs. 126.3±62.4min; P<0.001) times were longer in the PGF group. Total hospital mortality was 4.8%, 1.3% for non-PGF and 17% for PGF;P<0.001.Survival at 1, 5 and 10 years was 95.5±1.3%vs.55.3±7.3%, 84.1±2.5% vs. 47.4±7.6% and 67.1±3.8% vs. 14.4±12.0%, respectively, for non-PGF and PGF groups (P<0.001).

Discussão e Conclusões

This data confirms PGF as a not so infrequent early complication of cardiac transplantation, with dismal prognosis. High mortality and morbidity from PGF extends beyond the first month post-transplantation. Risk factors were identified and, if not avoidable, should be viewed as alarm flags to closely monitor the patients.

Palavras Chave

Primary graft failure