BACKGROUND: Early graft failure is associated with high mortality and is the main cause of death within the first 30 days after transplantation. The purpose of the present study was to examine the investigators' experience of severe perioperative acute graft failure and to review the literature. METHODS: Nine of 385 cardiac transplants (2.3%) performed from 1984 through 2005 developed severe perioperative acute graft failure either in the operating room or within 24 h after cardiac transplantation. Four patients had primary graft failure, two had right heart failure secondary to pulmonary hypertension, one had hyperacute rejection, one had accelerated acute rejection and one possibly sustained a particulate coronary embolus intraoperatively. RESULTS: All except the two patients who had right heart failure secondary to pulmonary hypertension received mechanical circulatory support. Three patients were supported with total artificial hearts, two patients received a left ventricular assist device, one patient was supported with extracorporeal life support followed by a right ventricular assist device when the left ventricle recovered, and one patient was supported for several hours with cardiopulmonary bypass. Three patients were retransplanted after mechanical circulatory support, but only one survived. Only one of the nine patients (11%) survived; this patient was supported with a total artificial heart followed by retransplantation. CONCLUSION: The outcome of severe perioperative acute graft failure is very poor. Mechanical circulatory support and retransplantation are not as successful as in other situations. Due to the shortage of donors and poor outcomes, retransplantation for hyperacute rejection is not advisable.
BACKGROUND: Early graft failure is associated with high mortality and is the main cause of death within the first 30 days after transplantation. The purpose of the present study was to examine the investigators' experience of severe perioperative acute graft failure and to review the literature. METHODS: Nine of 385 cardiac transplants (2.3%) performed from 1984 through 2005 developed severe perioperative acute graft failure either in the operating room or within 24 h after cardiac transplantation. Four patients had primary graft failure, two had right heart failure secondary to pulmonary hypertension, one had hyperacute rejection, one had accelerated acute rejection and one possibly sustained a particulate coronary embolus intraoperatively. RESULTS: All except the two patients who had right heart failure secondary to pulmonary hypertension received mechanical circulatory support. Three patients were supported with total artificial hearts, two patients received a left ventricular assist device, one patient was supported with extracorporeal life support followed by a right ventricular assist device when the left ventricle recovered, and one patient was supported for several hours with cardiopulmonary bypass. Three patients were retransplanted after mechanical circulatory support, but only one survived. Only one of the nine patients (11%) survived; this patient was supported with a total artificial heart followed by retransplantation. CONCLUSION: The outcome of severe perioperative acute graft failure is very poor. Mechanical circulatory support and retransplantation are not as successful as in other situations. Due to the shortage of donors and poor outcomes, retransplantation for hyperacute rejection is not advisable.
Authors: Jose M Arribas; Domingo A Pascual; Francisco Gutiérrez; Víctor Ray; Julio García-Puente; Mariano Valdés; Ramón Arcas Journal: Ann Thorac Surg Date: 2004-02 Impact factor: 4.330
Authors: D S Esmore; P M Spratt; J M Branch; A M Keogh; R P Lee; A E Farnsworth; M X Shanahan; V P Chang Journal: J Heart Transplant Date: 1990 Mar-Apr
Authors: Branislav Radovancevic; David C McGiffin; Jon A Kobashigawa; Guillermo B Cintron; G Martin Mullen; Douglas E Pitts; Jacqueline O'Donnell; Cindi Thomas; Robert C Bourge; David C Naftel Journal: J Heart Lung Transplant Date: 2003-08 Impact factor: 10.247
Authors: T B Icenogle; R J Williams; R G Smith; M Cleavinger; M A Vasu; B Rhenman; J G Copeland Journal: Ann Thorac Surg Date: 1989-04 Impact factor: 4.330
Authors: Katalin Martits-Chalangari; Omar Hernandez; Aayla K Jamil; Huanying Qin; Joost Felius; Samuel Jacob; Brian Lima; Aldo Rafael; Gonzalo V Gonzalez-Stawinski; Melody J Sherwood; Shelley A Hall Journal: Proc (Bayl Univ Med Cent) Date: 2018-10-18
Authors: Marcus Franz; K Grün; P Richter; B R Brehm; M Fritzenwanger; K Hekmat; D Neri; J Gummert; H R Figulla; H Kosmehl; A Berndt; A Renner Journal: Histochem Cell Biol Date: 2010-10-08 Impact factor: 4.304
Authors: Victor H Nieto Estrada; Daniel L Molano Franco; Albert A Valencia Moreno; Jose A Rojas Gambasica; Cristian C Cortes Nunez Journal: Cardiol Res Date: 2016-12-31