- 作者：M. Dolores G. Cos铆o Carmena ; Manuel G贸mez Bueno ; Luis Almenar ; Juan F. Delgado ; Jose M. Ariz贸n ; Francisco Gonz谩lez Vilchez ; Maria G. Crespo-Leiro ; Sonia Mirabet ; Eulalia Roig ; F茅lix P茅rez Villa ; Juan F. Fern谩ndez-Ya帽ez ; Jose L. Lambert ; Nicol谩s Manito ; Luis Fuente ; Maria L. Sanz Julve ; Domingo Pascual ; Gregorio R谩bago ; Isabel Mill谩n ; Luis A. Alonso-Pulp贸n ; Javier Segovia ; et al.
- 关键词：primary early graft failure ; heart transplantation ; risk score ; complication ; early mortality
- 刊名：The Journal of Heart and Lung Transplantation
- 出版年：December, 2013
- 年：2013
- 卷：32
- 期：12
- 页码：1187-1195
- 全文大小：680 K
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 鈮?10 mm Hg; age (A) 鈮?60 years; diabetes (D) mellitus, and inotrope (I) dependence; donor age (A) 鈮?30 years, and length (L) of ischemia 鈮?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 卤 1.1 vs 2.42 卤 1.1,
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.