Skip to main content
SpringerLink
Log in

Incidence, etiology, and outcome of primary graft dysfunction in adult heart transplant recipients: a single-center experience in Japan

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Donor and recipient characteristics, as well as donor–recipient matching, affect clinical outcomes after heart transplantation (HTx). This study aimed to clarify how donor and recipient characteristics affect the clinical course after HTx. The medical records of all the patients who underwent HTx at the National Cerebral and Cardiovascular Center from 1999 to 2014 were retrospectively reviewed. Sixty-one patients (48 males) underwent HTx. Six recipients (9.8 %) developed primary graft dysfunction (PGD) determined by criteria recently established at a consensus conference. Development of PGD was associated with high-dose inotropic support for the donor heart and a history of stroke in the recipient (p = 0.04 and p = 0.002, respectively). Recipients with PGD had higher right atrial pressure (RAP) and lower cardiac output (CO) compared with those without PGD at 6 months after HTx (RAP, 6.8 ± 3.6 vs. 2.8 ± 2.2 mmHg, p < 0.001; CO, 4.6 ± 0.8 l vs. 5.8 ± 1.2 l/min, p = 0.02). With respect to survival, patients with PGD had a 5-year survival rate equivalent to those without PGD (83.3 vs. 93.3 %, p = 0.23). High-dose inotropic support for the donor heart and a history of stroke in the recipient are significant predictive factors for the development of PGD. However, recipients with PGD demonstrate mid-term survival comparable to those without PGD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lund LH, Edwards LB, Kucheryavaya AY, Dipchand AI, Benden C, Christie JD, Dobbels F, Kirk R, Rahmel AO, Yusen RD, Stehlik J (2013) The registry of the international society for heart and lung transplantation: thirtieth official adult heart transplant report-2013; focus theme: age. J Heart Lung Transplant 32:951–964

    Article  PubMed  Google Scholar 

  2. Shah KB, Parameshwar J (2011) Advances in heart transplantation: the year in review. J Heart Lung Transplant 30:241–246

    Article  PubMed  Google Scholar 

  3. Toyoda Y, Guy TS, Kashem A (2013) Present status and future perspectives of heart transplantation. Circ J 77:1097–1110

    Article  CAS  PubMed  Google Scholar 

  4. Fujita T, Toda K, Yanase M, Seguchi O, Murata Y, Ishibashi-Ueda H, Kobayashi J, Nakatani T (2012) Risk factors for post-transplant low output syndrome. Eur J Cardiothorac Surg 42:551–556

    Article  PubMed  Google Scholar 

  5. D’Alessandro C, Golmard JL, Barreda E, Laali M, Makris R, Luyt CE, Leprince P, Pavie A (2011) Predictive risk factors for primary graft failure requiring temporary extra-corporeal membrane oxygenation support after cardiac transplantation in adults. Eur J Cardiothorac Surg 40:962–969

    PubMed  Google Scholar 

  6. Russo MJ, Iribarne A, Hong KN, Ramlawi B, Chen JM, Takayama H, Mancini DM, Naka Y (2010) Factors associated with primary graft failure after heart transplantation. Transplantation 90:444–450

    Article  PubMed  Google Scholar 

  7. D’Ancona G, Santise G, Falletta C, Pirone F, Sciacca S, Turrisi M, Biondo D, Pilato M (2010) Primary graft failure after heart transplantation: the importance of donor pharmacological management. Transplant Proc 42:710–712

    Article  PubMed  Google Scholar 

  8. Segovia J, Cosío MD, Barceló JM, Bueno MG, Pavía PG, Burgos R, Serrano-Fiz S, García-Montero C, Castedo E, Uqarte J, Alonso-Pulpón L (2011) RADIAL: a novel primary graft failure risk score in heart transplantation. J Heart Lung Transplant 30:644–651

    Article  PubMed  Google Scholar 

  9. Iyer A, Kumarasinghe G, Hicks M, Watson A, Gao L, Doyle A, Keogh A, Kotlyar E, Hayward C, Dhital K, Granger E, Jansz P, Pye R, Spratt P, Macdonald PS (2011) Primary graft failure after heart transplantation. J Transplant 2011:175768

    PubMed  PubMed Central  Google Scholar 

  10. Kobashigawa J, Zukermann A, Macdonald P, Leprince P, Esmailian F, Luu M, Mancini D, Patel J, Razi R, Reichenspurner H, Russell S, Segovia J, Smedira N, Stehlik J, Wagner F, Consensus Conference perticipants (2014) Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant 33:327–340

    Article  PubMed  Google Scholar 

  11. Yates JW, Chalmer B, McKegney FP (1980) Evaluation of patients with advanced cancer using the Karnofsky performance status. Cancer 45:2220–2224

    Article  CAS  PubMed  Google Scholar 

  12. Hashimoto S, Kato TS, Komamura K, Hanatani A, Niwaya K, Funatsu T, Kobayashi J, Sumita Y, Tanaka N, Hashimura K, Asakura M, Kanzaki H, Kitakaze M (2011) Utility of echocardiographic eveluation of donor hearts upon the organ procurement for heart transplantation. J Cardiol 57:215–222

    Article  PubMed  Google Scholar 

  13. De Santo LS, Amarelli C, Romano G, Della Corte A, Maiello C, Giannolo B, Marra C, De Feo M, Scardone M, Cotrufo M (2006) High-risk heart grafts: effective preservation with Celsior solution. Heart Vessels 21:89–94

    Article  PubMed  Google Scholar 

  14. Kitamura S, Nakatani T, Bando K, Sasako Y, Kobayashi J, Yagihara T (2001) Modification of bicaval anastomosis technique for orthotopic heart transplantation. Ann Thorac Surg 72:1405–1406

    Article  CAS  PubMed  Google Scholar 

  15. Nakatani T (2009) Heart transplantation. Circ J 73(suppl A):A55–A60

    Article  PubMed  Google Scholar 

  16. Fukushima N, Miyamoto Y, Ohtake S, Sawa Y, Takahashi T, Nishimura M (2004) Early result of heart transplantation in Japan: Osaka University experience. Asian Cardiovasc Thorac Am 12:1554–1558

    Google Scholar 

  17. Kitamura S (2012) Heart transplantation in Japan: a critical appraisal for the results and future prospects. Gen Thorac Cardiovasc Surg 60:639–644

    Article  PubMed  Google Scholar 

  18. Toda K, Fujita T, Kobayashi J, Shimahara Y, Kitamura S, Seguchi O, Murata Y, Yanase M, Nakatani T (2012) Impact of preoperative percutaneous cardiopulmonary support on outcome following left ventricular assist device implantation. Circ J 76:88–95

    Article  CAS  PubMed  Google Scholar 

  19. Ibrahim M, Hendry P, Masters R, Rubens F, Lam BK, Ruel M, Davies R, Haddad H, Veinot JP, Mesana T (2007) Management of acute severe perioperative failure of cardiac allografts: a single-center experience with a review of the literature. Can J Cardiol 23:363–367

    Article  PubMed  PubMed Central  Google Scholar 

  20. Listijono DR, Watson A, Pye R, Keogh AM, Kotlyar E, Spratt P, Granger E, Dhital K, Jansz P, Macdonald PS, Hayward CS (2011) Usefulness of extracorporeal membrane oxygenation for early cardiac allograft dysfunction. J Heart Lung Transplant 30:783–789

    Article  PubMed  Google Scholar 

  21. Marasco SF, Esmore DS, Negri J, Rowland M, Newcomb A, Rosenfeldt FL, Bailey M, Richardson M (2005) Early institution of mechanical support improves outcomes in primary cardiac allograft failure. J Heart Lung Transplant 24:2037–2042

    Article  PubMed  Google Scholar 

  22. Lima B, Rajagopal K, Petersen RP, Shah AS, Soule B, Felker GM, Rogers JG, Lodge AJ, Milano CA (2006) Marginal cardiac allograft do not have increased primary graft dysfunction in alternate list transplantation. Circulation 114:I-27–I-32

    Article  Google Scholar 

  23. Amarelli C, De Santo LS, Marra C, Maiello C, Bancone C, Corte AD, Nappi G, Romano G (2012) Early graft failure after heart transplant: risk factors and implications for improved donor-recipient matching. Interact CardioVasc Thorac Surg 15:57–62

    Article  PubMed  PubMed Central  Google Scholar 

  24. Schnuelle P, Berger S, De Boer J, Persijn G, Van Der Woude FJ (2001) Effects of catecholamine application to braindead donors on graft survival in solid organ transplantation. Transplantation 72:455–463

    Article  CAS  PubMed  Google Scholar 

  25. Todd GL, Baroldi G, Pieper GM, Clayton FC, Eliot RS (1985) Experimental catecholamine-induced myocardial necrosis. I. Morphology, quantification and regional distribution of acute contraction band lesions. J Mol Cell Cardiol 17:317

    Article  CAS  PubMed  Google Scholar 

  26. Erbs S, Höllriegel R, Linke A, Beck EB, Adams V, Gielen S, Möbius-Winkler S, Sandri M, Kränkel N, Hambrecht R, Schuler G (2010) Exercise training in patients with advanced chronic heart failure (NYHA IIIb) promotes restoration of peripheral vasomotor function, induction of endogenous regeneration, and improvement of left ventricular function. Circ Heart Fail 4:486–494

    Article  Google Scholar 

  27. Conraads VM, Van Craenenbroeck EM, De Maeyer C, Van Berendoncks AM, Beckers PJ, Vrints CJ (2013) Unraveling new mechanisms of exercise intolerance in chronic heart failure: role of exercise training. Heart Fail Rev 18:65–77

    Article  PubMed  Google Scholar 

  28. Chen JM, Russo MJ, Hammond KM, Mancini DM, Kherani AR, Fal JM, Mazzeo PA, Pinney SP, Edwards NM, Naka Y (2005) Alternate waiting list strategies for heart transplantation maximize donor organ utilization. Ann Thorac Surg 80:224–228

    Article  PubMed  Google Scholar 

  29. Tallaj JA, Kirklin JK, Brown RN, Rayburn BK, Bourge RC, Benza RL, Pinderski L, Pamboukian S, McGiffin DC, Naftel DC (2007) Post-heart transplant diastolic dysfunction is a risk factor for mortality. J Am Coll Cardiol 50:1064–1069

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Hiroshi Nishioka, Akira Hatanaka, Megumi Komiyama, Rieko Sakai, Emiko Fujiwara, Chiyo Fujikawa, Eri Miyoshi, Ai Nagayo, Nobuaki Konishi, Shiho Tsuboi, and Yumiko Hori for their role in patient care.

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Transplantation, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan

    Osamu Seguchi, Yoshihiro Murata, Haruki Sunami, Takuma Sato, Takuya Watanabe, Seiko Nakajima, Kensuke Kuroda, Eriko Hisamatsu, Takamasa Sato, Masanobu Yanase & Takeshi Nakatani

  2. Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan

    Tomoyuki Fujita, Hiroki Hata & Junjiro Kobayashi

  3. Department of Pharmacy, National Cerebral and Cardiovascular Center, Osaka, Japan

    Kyoichi Wada

  4. Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan

    Hatsue Ishibashi-Ueda

Authors
  1. Osamu Seguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomoyuki Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshihiro Murata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haruki Sunami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takuma Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takuya Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seiko Nakajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kensuke Kuroda
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eriko Hisamatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takamasa Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masanobu Yanase
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hiroki Hata
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kyoichi Wada
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hatsue Ishibashi-Ueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Junjiro Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Takeshi Nakatani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Osamu Seguchi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seguchi, O., Fujita, T., Murata, Y. et al. Incidence, etiology, and outcome of primary graft dysfunction in adult heart transplant recipients: a single-center experience in Japan. Heart Vessels 31, 555–562 (2016). https://doi.org/10.1007/s00380-015-0649-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-015-0649-1

Keywords

Search

Navigation