Background:Since the international consensus on primary graft dysfunction (PGD) following heart transplantation (HT) was reported in 2014, few clinical studies have been reported. We aimed to analyze the incidence, predictive factors, and clinical implications of PGD following the International Society of Heart and Lung Transplant criteria in a single center.

Methods and Results:This study enrolled 570 consecutive adult patients undergoing isolated HT between November 1992 and December 2017. Under a new set of criteria, PGD-left ventricle (PGD-LV) occurred in 35 patients (6.1%; mild, n=1 [0.2%]; moderate, n=14 [2.5%]; severe, n=20 [3.5%]), whereas PGD-right ventricle (PGD-RV) occurred in 3 (0.5%). Multivariable analysis demonstrated that preoperative admission (odds ratio [OR] 4.20; 95% confidence interval [CI] 1.24–14.26; P=0.021), preoperative extracorporeal membrane oxygenation (OR 4.03; 95% CI 1.75–9.26; P=0.001), and prolonged total ischemic time (OR 1.09; 95% CI 1.02–1.15; P=0.006) were significant predictors of moderate to severe PGD-LV. Moderate to severe PGD-LV was an independent and significant risk factor for early death (OR 55.64; 95% CI 11.65–265.73; P<0.001), with its effects extending up to 3 months after HT.

Conclusions:Moderate to severe PGD-LV, as defined by the new guidelines, is an important predictor of early mortality, with effects extending up to 3 months after HT. Efforts to reduce the occurrence of moderate to severe PGD-LV may lead to better outcomes.

背景：自 2014 年报道心脏移植 (HT) 后原发性移植物功能障碍 (PGD) 的国际共识以来，很少有临床研究报道。我们旨在根据国际心肺移植学会标准在一个中心分析 PGD 的发生率、预测因素和临床意义。

方法和结果：该研究招募了 1992 年 11 月至 2017 年 12 月期间接受单独 HT 的 570 名连续成年患者。根据一套新标准，PGD 左心室 (PGD-LV) 发生在 35 名患者中（6.1%；轻度，n=1 [0.2%] ；中度，n=14 [2.5%]；重度，n=20 [3.5%])，而 PGD-右心室 (PGD-RV) 发生在 3 例 (0.5%)。多变量分析表明，术前入院（优势比 [OR] 4.20；95% 置信区间 [CI] 1.24-14.26；P=0.021），术前体外膜肺氧合（OR 4.03；95% CI 1.75-9.26；P=0.001），和延长的总缺血时间（OR 1.09；95% CI 1.02-1.15；P=0.006）是中度至重度 PGD-LV 的重要预测因素。中度至重度 PGD-LV 是早期死亡的独立且显着的危险因素（OR 55.64；95% CI 11.65–265.73；P<0.001），

结论：新指南定义的中度至重度 PGD-LV 是早期死亡率的重要预测指标，其影响可延长至 HT 后 3 个月。努力减少中度至重度 PGD-LV 的发生可能会带来更好的结果。