Risk factors for primary graft dysfunction after heart transplantation—a systematic review and meta-analysis

Background: Primary graft dysfunction (PGD) is an important contributor to early mortality after heart transplantation (HTX). The International Society for Heart and Lung Transplantation (ISHLT) published a consensus definition of primary graft dysfunction in 2014. We conducted a systematic review and meta-analysis of published literature to identify risk factors for primary graft dysfunction according to this consensus definition. Methods: According to PRISMA-guidelines, eligible studies were identified using Medline, Embase, and Cochrane. Studies were included if focused on patients ≥18 years old who received a primary, isolated HTX and outcome was specified as PGD according to the ISHLT consensus definition. Risk factors for severe PGD were included in meta-analysis if reported in ≥2 studies. Results: A total of 39 studies were included. Significant heterogeneity was noted. A total of 37 risk factors for PGD were identified. Meta-analysis identified recipient amiodarone therapy, female sex of the donor, recipient prior sternotomy (other than for LVAD implantation), recipient LVAD therapy and cold ischemic time per hour increment as risk factors for severe PGD. Blood product administration was associated with severe PGD in multiple studies, but was excluded from meta-analysis due to heterogeneity in definition. Conclusion: In this systematic review, we identified a total of 37 risk factors for PGD, while meta-analysis solidified amiodarone therapy, female sex of the donor, recipient prior sternotomy (other than for LVAD implantation), recipient LVAD therapy and cold ischemic time per hour increment as risk factors for severe PGD. Blood product administration was associated with severe PGD in multiple studies, but was excluded from meta-analysis due to heterogeneity in definition.