초록접수 현황
| 14F-251 | 포럼 발표 |
Primary Graft Dysfunction According to the New Criteria after Heart Transplantation: Asan Medical Center Experience
Ho Jin Kim¹, Sung-Ho Jung¹, Jae Joong Kim², Jae Suk Yoo¹, Joon Bum Kim¹, Suk Jung Choo¹, Tae-Jin Yun¹, Cheol Hyun Chung¹, Jae Won Lee¹
Department of Thoracic and Cardiovascular Surgery¹, Division of Cardiology², Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Background : Although primary graft dysfunction (PGD) is a severe complication thought to be fairly common after heart transplantation, its diagnostic criteria and treatment protocols had not been standardized. At the 33rd Annual International Society of Heart and Lung Transplantation (ISHLT) meeting in 2013, the new guidelines were established to better define and diagnose PGD. Following these guidelines, we sought to identify the patients with PGD and evaluate the risk factors causing PGD and its implications affecting clinical outcomes after heart transplantation in our institution.
Methods : We reviewed the consecutive 372 patients aged 17 years or older (aged 45.2 ± 13.3 years, 104 females) who underwent orthotopic heart transplantation from November 1992 through August 2013 at the Asan Medical Center. The patients with multi-organ transplantation were not included. The patients who met the new criteria of PGD were identified and classified into PGD-right ventricle (RV) and PGD-left ventricle (LV). Predictors for moderate-to-severe PGD-LV and its clinical impacts on early- and long-term survival were evaluated with the use of multivariable analysis.
Results : PGD-RV was diagnosed in 3 patients (0.8%) and PGD-LV occurred in 36 patients (9.7%): mild (n=2, 0.5%), moderate (n=24, 6.5%), and severe (n=10, 2.7%). On multivariable analysis, pre-operative extracorporeal membrane oxygenation (ECMO) support (relative risk, 4.70, 95% confidence interval [CI], 1.49-14.83; P=0.008) and longer total ischemic time (> 3 hours) (relative risk, 2.62, 95% CI, 1.27-5.40; P=0.009) emerged as significant and independent predictors for moderate-to-severe PGD-LV. During a median follow-up period of 60.0 months (interquartile range, 29.0-109.0), 79 patients (21.2%) died. Patients sustaining moderate-to-severe PGD-LV had a higher risk of early mortality as well as overall mortality during the whole study period: the risk of in-hospital mortality of 11.25 (95% CI, 2.57-49.27; P=0.001) and the risk of overall mortality of 2.76 (95% CI, 1.41-5.43; P=0.003).
Conclusion : Moderate-to-severe PGD-LV defined by the new criteria is a good predictor for early- as well as long-term mortality. The development of recipient management in critical status and better donor heart preservation may reduce the incidence of PGD and improve the overall survival.
Methods : We reviewed the consecutive 372 patients aged 17 years or older (aged 45.2 ± 13.3 years, 104 females) who underwent orthotopic heart transplantation from November 1992 through August 2013 at the Asan Medical Center. The patients with multi-organ transplantation were not included. The patients who met the new criteria of PGD were identified and classified into PGD-right ventricle (RV) and PGD-left ventricle (LV). Predictors for moderate-to-severe PGD-LV and its clinical impacts on early- and long-term survival were evaluated with the use of multivariable analysis.
Results : PGD-RV was diagnosed in 3 patients (0.8%) and PGD-LV occurred in 36 patients (9.7%): mild (n=2, 0.5%), moderate (n=24, 6.5%), and severe (n=10, 2.7%). On multivariable analysis, pre-operative extracorporeal membrane oxygenation (ECMO) support (relative risk, 4.70, 95% confidence interval [CI], 1.49-14.83; P=0.008) and longer total ischemic time (> 3 hours) (relative risk, 2.62, 95% CI, 1.27-5.40; P=0.009) emerged as significant and independent predictors for moderate-to-severe PGD-LV. During a median follow-up period of 60.0 months (interquartile range, 29.0-109.0), 79 patients (21.2%) died. Patients sustaining moderate-to-severe PGD-LV had a higher risk of early mortality as well as overall mortality during the whole study period: the risk of in-hospital mortality of 11.25 (95% CI, 2.57-49.27; P=0.001) and the risk of overall mortality of 2.76 (95% CI, 1.41-5.43; P=0.003).
Conclusion : Moderate-to-severe PGD-LV defined by the new criteria is a good predictor for early- as well as long-term mortality. The development of recipient management in critical status and better donor heart preservation may reduce the incidence of PGD and improve the overall survival.
책임저자: 정성호
울산대학교 의과대학 서울아산병원 흉부외과학교실
연락처 : 김호진, Tel: 02-3010-3580 , E-mail : rhonin.hojin@gmail.com
