Role of Donor-Recipient Match in Determining the Risk for Primary Graft Failure after Heart Transplantation

Purpose Non-functional recovery of the graft (primary graft failure, PGF) is still the major cause of early adverse outcome after heart transplantation (HT). While several donor- and recipient-related factors have been taken into account to explain PGF onset, few data are available analyzing how donor-recipient match may be optimized to reduce PGF occurrence. In this study, we explored PGF risk factors, aiming to identify specific donor-recipient matches associated with PGF onset. Methods and Materials We reviewed data from all adult patients transplanted between 1999 and 2011 at our center, including those with pre-HT laboratory and hemodynamic data availability. Study endpoint was occurrence of PGF defined as need of mechanical circulatory support with ECMO/intra-aortic balloon pump, or cardiac index Results Out of 370 patients included, 63(17%) presented PGF. Among all clinical and laboratory variables analyzed, recipient female sex (P Conclusions Female gender and high GTP independently predicted PGF onset. Allocation of donors died of cerebral hemorrhage to recipients with high RVP, or of undersized donors to female recipients, markedly increased PGF risk. Underscoring the importance of strategies directed at controlling reactive pulmonary hypertension before HT, this study suggests that development of customized allocation algorythms may signifcantly improve post-HT outcomes.