Detalle Publicación


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

Autores: Cosío Carmena, M. D. G.; Gómez Bueno, M.; Almenar, L.; Delgado, J. F.; Arizon, J. M.; González Vílchez, F.; Crespo Leiro, M. G.; Mirabet, S.; Roig, E.; Pérez Villa, F.; Fernandez Yanez, J. F.; Lambert, J. L.; Manito, N.; Fuente, L.; Sanz Julve, M. L.; Pascual, D.; Rabago Juan Aracil, Gregorio; Millan, I.; Alonso Pulpon, L. A.; Segovia, J.
ISSN: 1053-2498
Volumen: 32
Número: 12
Páginas: 1187 - 1195
Fecha de publicación: 2013
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. (C) 2013 International Society for Heart and Lung Transplantation. All rights reserved.