Objectives: In this study, we aimed to perform a meta-analysis of the present literature,
in order to determinate parameters independently associated with the development of
cardiac primary graft dysfunction (PGD).
Background: Primary graft dysfunction represents one of the major causes of early
mortality after a heart transplantation. It manifests itself as a ventricular dysfunction in
the immediate post-transplant period and is not a consequence of hyperacute rejection,
pulmonary hypertension, cardiac tamponade or any surgical complication. Its cause is
complex and involves a multitude of risk factors: some relative to the donor, some to the
recipient as well as procedural factors. Considering the actual situation of donor shortage,
it is crucial to expand our knowledge of PGD to decrease its mortality and better allocate
marginal donor hearts. A new definition and new classification were issued by the ISHLT
in 2013, enabling better homogeneity between studies.
Method: A systematic literature search was conducted. The selected studies included
those which analysed the association between risk factors and PGD in a multivariate
analysis and all used the new definition by the ISHLT. The data was then extracted, and
any risk factor identified in a multivariable model in two or more studies was included in
our meta-analysis.
Results: 28 studies met the inclusion criteria for analysis. Through this meta-analysis,
we highlighted following risk factors : Lower donor ejection fraction (OR 1.07; 95%CI
1.02-1.12), preoperative levothyroxine therapy (OR 2.83; 95%CI 1.18-6.78), one hour
increase in total ischemic time (OR 1.66; 95%CI 1.42-1.95), increased perioperative use
of blood products (OR 1.18; 95%CI 1.08-1.28), increased preoperative recipient
creatinine (OR 3.26; 95%CI 1.71-6.21), recipient preoperative use of MCS (OR 2.60;
95%CI 1.51-4.48), pre-transplantation heart surgery (OR 1.85; 95%CI 1.10-3.13),
preoperative hospitalization (OR 3.35; 95%CI 1.52-7.40) and recipient amiodarone (OR
1.89; 95%CI 1.11-3.22).
Conclusion: While there remain areas of uncertainty, such as the impact of donor age,
our meta-analysis found multiple procedural, donor-related and recipient-related factors
associated with PGD and that therefore could predict PGD risk. Efforts to optimize
recipient management, including the judicious use of medications and advancements in
perioperative care, may help mitigate these risks.