Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
J Heart Lung Transplant. 2024 Jul;43(7):1153-1161. doi: 10.1016/j.healun.2024.03.010. Epub 2024 Mar 19.
Severe primary graft dysfunction (PGD) is a major cause of early mortality after heart transplant, but the impact of donor organ preservation conditions on severity of PGD and survival has not been well characterized.
Data from US adult heart-transplant recipients in the Global Utilization and Registry Database for Improved Heart Preservation-Heart Registry (NCT04141605) were analyzed to quantify PGD severity, mortality, and associated risk factors. The independent contributions of organ preservation method (traditional ice storage vs controlled hypothermic preservation) and ischemic time were analyzed using propensity matching and logistic regression.
Among 1,061 US adult heart transplants performed between October 2015 and December 2022, controlled hypothermic preservation was associated with a significant reduction in the incidence of severe PGD compared to ice (6.6% [37/559] vs 10.4% [47/452], p = 0.039). Following propensity matching, severe PGD was reduced by 50% (6.0% [17/281] vs 12.1% [34/281], respectively; p = 0.018). The Kaplan-Meier terminal probability of 1-year mortality was 4.2% for recipients without PGD, 7.2% for mild or moderate PGD, and 32.1%, for severe PGD (p < 0.001). The probability of severe PGD increased for both cohorts with longer ischemic time, but donor hearts stored on ice were more likely to develop severe PGD at all ischemic times compared to controlled hypothermic preservation.
Severe PGD is the deadliest complication of heart transplantation and is associated with a 7.8-fold increase in probability of 1-year mortality. Controlled hypothermic preservation significantly attenuates the risk of severe PGD and is a simple yet highly effective tool for mitigating post-transplant morbidity.
严重原发性移植物功能障碍（PGD）是心脏移植后早期死亡的主要原因，但供体器官保存条件对 PGD 严重程度和生存率的影响尚未得到很好的描述。
分析了来自美国成人心脏移植受者的全球利用和登记数据库，以量化 PGD 严重程度、死亡率和相关风险因素。使用倾向匹配和逻辑回归分析器官保存方法（传统冰储存与控制性低温保存）和缺血时间的独立贡献。
在 2015 年 10 月至 2022 年 12 月期间进行的 1061 例美国成人心脏移植中，与冰保存相比，控制性低温保存与严重 PGD 的发生率显著降低（6.6%[37/559] vs 10.4%[47/452]，p=0.039）。在进行倾向匹配后，严重 PGD 降低了 50%（6.0%[17/281] vs 12.1%[34/281]，p=0.018）。无 PGD 受者的 1 年死亡率的 Kaplan-Meier 终期概率为 4.2%，轻度或中度 PGD 为 7.2%，严重 PGD 为 32.1%（p<0.001）。缺血时间较长的两组发生严重 PGD 的概率均增加，但与控制性低温保存相比，冰保存的供心在所有缺血时间发生严重 PGD 的可能性更大。
严重 PGD 是心脏移植最致命的并发症，与 1 年死亡率增加 7.8 倍相关。控制性低温保存可显著降低严重 PGD 的风险，是减轻移植后发病率的简单而有效的工具。
