Primary graft failure after heart transplantation: Characteristics in a contemporary cohort and performance of the RADIAL risk score
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, mort...
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| Veröffentlicht in: | The Journal of heart and lung transplantation 2013-12, Vol.32 (12), p.1187-1195 |
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| creator | Cosío Carmena, M. Dolores G., MD, PhD Gómez Bueno, Manuel, MD Almenar, Luis, MD Delgado, Juan F., MD, PhD Arizón, Jose M., MD González Vilchez, Francisco, MD Crespo-Leiro, Maria G., MD, PhD Mirabet, Sonia, MD Roig, Eulalia, MD, PhD Pérez Villa, Félix, MD, PhD Fernández-Yañez, Juan F., MD Lambert, Jose L., MD Manito, Nicolás, MD Fuente, Luis, MD Sanz Julve, Maria L., MD Pascual, Domingo, MD Rábago, Gregorio, MD Millán, Isabel, MD Alonso-Pulpón, Luis A., MD, PhD Segovia, Javier, MD, PhD |
| description | 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 ≥ 10 mm Hg; age (A) ≥ 60 years; diabetes (D) mellitus, and inotrope (I) dependence; donor age (A) ≥ 30 years, and length (L) of ischemia ≥ 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 ± 1.1 vs 2.42 ± 1.1, p = 0.001) and stratified 3 groups with incremental PGF incidence: low risk (12.1%), intermediate risk (19.4%), and high risk (27.5%, p = 0.001). 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. |
| doi_str_mv | 10.1016/j.healun.2013.08.004 |
| format | Article |
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Dolores G., MD, PhD ; Gómez Bueno, Manuel, MD ; Almenar, Luis, MD ; Delgado, Juan F., MD, PhD ; Arizón, Jose M., MD ; González Vilchez, Francisco, MD ; Crespo-Leiro, Maria G., MD, PhD ; Mirabet, Sonia, MD ; Roig, Eulalia, MD, PhD ; Pérez Villa, Félix, MD, PhD ; Fernández-Yañez, Juan F., MD ; Lambert, Jose L., MD ; Manito, Nicolás, MD ; Fuente, Luis, MD ; Sanz Julve, Maria L., MD ; Pascual, Domingo, MD ; Rábago, Gregorio, MD ; Millán, Isabel, MD ; Alonso-Pulpón, Luis A., MD, PhD ; Segovia, Javier, MD, PhD</creator><creatorcontrib>Cosío Carmena, M. Dolores G., MD, PhD ; Gómez Bueno, Manuel, MD ; Almenar, Luis, MD ; Delgado, Juan F., MD, PhD ; Arizón, Jose M., MD ; González Vilchez, Francisco, MD ; Crespo-Leiro, Maria G., MD, PhD ; Mirabet, Sonia, MD ; Roig, Eulalia, MD, PhD ; Pérez Villa, Félix, MD, PhD ; Fernández-Yañez, Juan F., MD ; Lambert, Jose L., MD ; Manito, Nicolás, MD ; Fuente, Luis, MD ; Sanz Julve, Maria L., MD ; Pascual, Domingo, MD ; Rábago, Gregorio, MD ; Millán, Isabel, MD ; Alonso-Pulpón, Luis A., MD, PhD ; Segovia, Javier, MD, PhD</creatorcontrib><description>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 ≥ 10 mm Hg; age (A) ≥ 60 years; diabetes (D) mellitus, and inotrope (I) dependence; donor age (A) ≥ 30 years, and length (L) of ischemia ≥ 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 ± 1.1 vs 2.42 ± 1.1, p = 0.001) and stratified 3 groups with incremental PGF incidence: low risk (12.1%), intermediate risk (19.4%), and high risk (27.5%, p = 0.001). 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.</description><identifier>ISSN: 1053-2498</identifier><identifier>EISSN: 1557-3117</identifier><identifier>DOI: 10.1016/j.healun.2013.08.004</identifier><identifier>PMID: 24263021</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Age Factors ; Cohort Studies ; complication ; Diabetes Complications - complications ; early mortality ; Female ; Graft Rejection - epidemiology ; Graft Rejection - physiopathology ; Heart Atria - physiopathology ; Heart Transplantation ; Humans ; Incidence ; Male ; Middle Aged ; primary early graft failure ; Retrospective Studies ; Risk Assessment - methods ; Risk Factors ; risk score ; Surgery ; Tissue Donors</subject><ispartof>The Journal of heart and lung transplantation, 2013-12, Vol.32 (12), p.1187-1195</ispartof><rights>International Society for Heart and Lung Transplantation</rights><rights>2013 International Society for Heart and Lung Transplantation</rights><rights>Copyright © 2013 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c529t-e397d00bb2bbb52d43ebf76db2020b6fcfbd001c90201be24933c1834881fb653</citedby><cites>FETCH-LOGICAL-c529t-e397d00bb2bbb52d43ebf76db2020b6fcfbd001c90201be24933c1834881fb653</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.healun.2013.08.004$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24263021$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cosío Carmena, M. Dolores G., MD, PhD</creatorcontrib><creatorcontrib>Gómez Bueno, Manuel, MD</creatorcontrib><creatorcontrib>Almenar, Luis, MD</creatorcontrib><creatorcontrib>Delgado, Juan F., MD, PhD</creatorcontrib><creatorcontrib>Arizón, Jose M., MD</creatorcontrib><creatorcontrib>González Vilchez, Francisco, MD</creatorcontrib><creatorcontrib>Crespo-Leiro, Maria G., MD, PhD</creatorcontrib><creatorcontrib>Mirabet, Sonia, MD</creatorcontrib><creatorcontrib>Roig, Eulalia, MD, PhD</creatorcontrib><creatorcontrib>Pérez Villa, Félix, MD, PhD</creatorcontrib><creatorcontrib>Fernández-Yañez, Juan F., MD</creatorcontrib><creatorcontrib>Lambert, Jose L., MD</creatorcontrib><creatorcontrib>Manito, Nicolás, MD</creatorcontrib><creatorcontrib>Fuente, Luis, MD</creatorcontrib><creatorcontrib>Sanz Julve, Maria L., MD</creatorcontrib><creatorcontrib>Pascual, Domingo, MD</creatorcontrib><creatorcontrib>Rábago, Gregorio, MD</creatorcontrib><creatorcontrib>Millán, Isabel, MD</creatorcontrib><creatorcontrib>Alonso-Pulpón, Luis A., MD, PhD</creatorcontrib><creatorcontrib>Segovia, Javier, MD, PhD</creatorcontrib><title>Primary graft failure after heart transplantation: Characteristics in a contemporary cohort and performance of the RADIAL risk score</title><title>The Journal of heart and lung transplantation</title><addtitle>J Heart Lung Transplant</addtitle><description>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 ≥ 10 mm Hg; age (A) ≥ 60 years; diabetes (D) mellitus, and inotrope (I) dependence; donor age (A) ≥ 30 years, and length (L) of ischemia ≥ 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 ± 1.1 vs 2.42 ± 1.1, p = 0.001) and stratified 3 groups with incremental PGF incidence: low risk (12.1%), intermediate risk (19.4%), and high risk (27.5%, p = 0.001). 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.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Cohort Studies</subject><subject>complication</subject><subject>Diabetes Complications - complications</subject><subject>early mortality</subject><subject>Female</subject><subject>Graft Rejection - epidemiology</subject><subject>Graft Rejection - physiopathology</subject><subject>Heart Atria - physiopathology</subject><subject>Heart Transplantation</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>primary early graft failure</subject><subject>Retrospective Studies</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>risk score</subject><subject>Surgery</subject><subject>Tissue Donors</subject><issn>1053-2498</issn><issn>1557-3117</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFksuO1DAQRSMEYoaBP0DISzYJZTtJJyyQWj08RmoJxGNt2U6Zdk9iB9tBmj0fjqMMLNiwcll17y3VURXFcwoVBdq-OlcnlOPiKgaUV9BVAPWD4pI2za7klO4e5hoaXrK67y6KJzGeAYDxhj0uLljNWg6MXha_PgU7yXBHvgdpEjHSjktAkmsMJA8IiaQgXZxH6ZJM1rvX5HCSQeossDFZHYl1RBLtXcJp9mEN0_7ks1O6gcwYjA-TdBqJNySdkHzeX9_sjyTbb0nUPuDT4pGRY8Rn9-9V8e3d26-HD-Xx4_ubw_5Y6ob1qUTe7wYApZhSqmFDzVGZXTsoBgxUa7RRuU11n79UYV6cc007XncdNapt-FXxcsudg_-xYExislHjmHdDv0RB65bymnHaZ2m9SXXwMQY0Yt5ACQpi5S_OYuMvVv4COpH5Z9uL-wmLmnD4a_oDPAvebALMe_60GETUFjOcwQbUSQze_m_CvwF6tM5qOd7iHcazX4LLDAUVkQkQX9YbWE-A8hzSQct_A2eNrxI</recordid><startdate>20131201</startdate><enddate>20131201</enddate><creator>Cosío Carmena, M. Dolores G., MD, PhD</creator><creator>Gómez Bueno, Manuel, MD</creator><creator>Almenar, Luis, MD</creator><creator>Delgado, Juan F., MD, PhD</creator><creator>Arizón, Jose M., MD</creator><creator>González Vilchez, Francisco, MD</creator><creator>Crespo-Leiro, Maria G., MD, PhD</creator><creator>Mirabet, Sonia, MD</creator><creator>Roig, Eulalia, MD, PhD</creator><creator>Pérez Villa, Félix, MD, PhD</creator><creator>Fernández-Yañez, Juan F., MD</creator><creator>Lambert, Jose L., MD</creator><creator>Manito, Nicolás, MD</creator><creator>Fuente, Luis, MD</creator><creator>Sanz Julve, Maria L., MD</creator><creator>Pascual, Domingo, MD</creator><creator>Rábago, Gregorio, MD</creator><creator>Millán, Isabel, MD</creator><creator>Alonso-Pulpón, Luis A., MD, PhD</creator><creator>Segovia, Javier, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20131201</creationdate><title>Primary graft failure after heart transplantation: Characteristics in a contemporary cohort and performance of the RADIAL risk score</title><author>Cosío Carmena, M. Dolores G., MD, PhD ; Gómez Bueno, Manuel, MD ; Almenar, Luis, MD ; Delgado, Juan F., MD, PhD ; Arizón, Jose M., MD ; González Vilchez, Francisco, MD ; Crespo-Leiro, Maria G., MD, PhD ; Mirabet, Sonia, MD ; Roig, Eulalia, MD, PhD ; Pérez Villa, Félix, MD, PhD ; Fernández-Yañez, Juan F., MD ; Lambert, Jose L., MD ; Manito, Nicolás, MD ; Fuente, Luis, MD ; Sanz Julve, Maria L., MD ; Pascual, Domingo, MD ; Rábago, Gregorio, MD ; Millán, Isabel, MD ; Alonso-Pulpón, Luis A., MD, PhD ; Segovia, Javier, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c529t-e397d00bb2bbb52d43ebf76db2020b6fcfbd001c90201be24933c1834881fb653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Cohort Studies</topic><topic>complication</topic><topic>Diabetes Complications - complications</topic><topic>early mortality</topic><topic>Female</topic><topic>Graft Rejection - epidemiology</topic><topic>Graft Rejection - physiopathology</topic><topic>Heart Atria - physiopathology</topic><topic>Heart Transplantation</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>primary early graft failure</topic><topic>Retrospective Studies</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>risk score</topic><topic>Surgery</topic><topic>Tissue Donors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cosío Carmena, M. Dolores G., MD, PhD</creatorcontrib><creatorcontrib>Gómez Bueno, Manuel, MD</creatorcontrib><creatorcontrib>Almenar, Luis, MD</creatorcontrib><creatorcontrib>Delgado, Juan F., MD, PhD</creatorcontrib><creatorcontrib>Arizón, Jose M., MD</creatorcontrib><creatorcontrib>González Vilchez, Francisco, MD</creatorcontrib><creatorcontrib>Crespo-Leiro, Maria G., MD, PhD</creatorcontrib><creatorcontrib>Mirabet, Sonia, MD</creatorcontrib><creatorcontrib>Roig, Eulalia, MD, PhD</creatorcontrib><creatorcontrib>Pérez Villa, Félix, MD, PhD</creatorcontrib><creatorcontrib>Fernández-Yañez, Juan F., MD</creatorcontrib><creatorcontrib>Lambert, Jose L., MD</creatorcontrib><creatorcontrib>Manito, Nicolás, MD</creatorcontrib><creatorcontrib>Fuente, Luis, MD</creatorcontrib><creatorcontrib>Sanz Julve, Maria L., MD</creatorcontrib><creatorcontrib>Pascual, Domingo, MD</creatorcontrib><creatorcontrib>Rábago, Gregorio, MD</creatorcontrib><creatorcontrib>Millán, Isabel, MD</creatorcontrib><creatorcontrib>Alonso-Pulpón, Luis A., MD, PhD</creatorcontrib><creatorcontrib>Segovia, Javier, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of heart and lung transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cosío Carmena, M. Dolores G., MD, PhD</au><au>Gómez Bueno, Manuel, MD</au><au>Almenar, Luis, MD</au><au>Delgado, Juan F., MD, PhD</au><au>Arizón, Jose M., MD</au><au>González Vilchez, Francisco, MD</au><au>Crespo-Leiro, Maria G., MD, PhD</au><au>Mirabet, Sonia, MD</au><au>Roig, Eulalia, MD, PhD</au><au>Pérez Villa, Félix, MD, PhD</au><au>Fernández-Yañez, Juan F., MD</au><au>Lambert, Jose L., MD</au><au>Manito, Nicolás, MD</au><au>Fuente, Luis, MD</au><au>Sanz Julve, Maria L., MD</au><au>Pascual, Domingo, MD</au><au>Rábago, Gregorio, MD</au><au>Millán, Isabel, MD</au><au>Alonso-Pulpón, Luis A., MD, PhD</au><au>Segovia, Javier, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Primary graft failure after heart transplantation: Characteristics in a contemporary cohort and performance of the RADIAL risk score</atitle><jtitle>The Journal of heart and lung transplantation</jtitle><addtitle>J Heart Lung Transplant</addtitle><date>2013-12-01</date><risdate>2013</risdate><volume>32</volume><issue>12</issue><spage>1187</spage><epage>1195</epage><pages>1187-1195</pages><issn>1053-2498</issn><eissn>1557-3117</eissn><abstract>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 ≥ 10 mm Hg; age (A) ≥ 60 years; diabetes (D) mellitus, and inotrope (I) dependence; donor age (A) ≥ 30 years, and length (L) of ischemia ≥ 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 ± 1.1 vs 2.42 ± 1.1, p = 0.001) and stratified 3 groups with incremental PGF incidence: low risk (12.1%), intermediate risk (19.4%), and high risk (27.5%, p = 0.001). 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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24263021</pmid><doi>10.1016/j.healun.2013.08.004</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Age Factors Cohort Studies complication Diabetes Complications - complications early mortality Female Graft Rejection - epidemiology Graft Rejection - physiopathology Heart Atria - physiopathology Heart Transplantation Humans Incidence Male Middle Aged primary early graft failure Retrospective Studies Risk Assessment - methods Risk Factors risk score Surgery Tissue Donors |
| title | Primary graft failure after heart transplantation: Characteristics in a contemporary cohort and performance of the RADIAL risk score |
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