Report from a consensus conference on primary graft dysfunction after cardiac transplantation
Report from a consensus conference on primary graft dysfunction after cardiac transplantation
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DOI：
10.1016/j.healun.2014.02.027
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发表时间：
2014-04-01
影响因子：
8.9
通讯作者：
Wagner, Florian
中科院分区：
文献类型：
--
作者：
Kobashigawa, Jon;Zuckermann, Andreas;Wagner, Florian
虽然原发性移植物功能障碍（PGD）在心脏移植后早期相当常见，但标准化的诊断和治疗方案仍存在争议。大多数主要的心脏移植中心使用不同的心脏功能定义和参数。因此，很难比较已发表的报告，也没有商定的管理方案。组织了一次共识会议，以更好地定义、诊断和管理PGD。共有71名参与者（移植心脏病学家、外科医生、免疫学家和病理学家），他们在PGD方面具有丰富的临床和已发表的经验，代表了全球42家心脏移植中心。最先进的项目前指导小组介绍了随后计划举行的分组会议，试图就各种问题达成共识。移植物功能障碍将分为原发性移植物功能障碍（PGD）或继发性移植物功能障碍，其中存在可辨别的原因，如超急性排斥反应、肺动脉高压或手术并发症。PGD必须在手术完成后24小时内诊断。PGD分为PGD-左心室和PGD-右心室。根据心脏功能水平和所需的正性肌力和机械支持程度，将PGD-左心室分为轻度、中度或重度。公认的PGD风险因素包括供体、受体和外科手术因素。推荐的治疗包括最大限度地减少风险因素、逐渐增加正性肌力药物以及根据需要使用机械循环支持。如果风险因素很小，可能需要再次移植。有了POD的标准化定义，对这种现象的认识将更加一致，治疗方式也将更具可比性。这将导致更好地了解PGD和预防/最大限度地减少其不良后果。(C)2014年国际心肺移植学会。All rights reserved.
Although primary graft dysfunction (PGD) is fairly common early after cardiac transplant, standardized schemes for diagnosis and treatment remain contentious. Most major cardiac transplant centers use different definitions and parameters of cardiac function. Thus, there is difficulty comparing published reports and no agreed protocol for management. A consensus conference was organized to better define, diagnose, and manage PGD. There were 71 participants (transplant cardiologists, surgeons, immunologists and pathologists), with vast clinical and published experience in PGD, representing 42 heart transplant centers worldwide. State-of-the-art PGD presentations occurred with subsequent breakout sessions planned in an attempt to reach consensus on various issues. Graft dysfunction will be classified into primary graft dysfunction (PGD) or secondary graft dysfunction where there is a discernible cause such as hyperacute rejection, pulmonary hypertension, or surgical complications. PGD must be diagnosed within 24 hours of completion of surgery. PGD is divided into PGD-left ventricle and PGD-right ventricle. PGD-left ventricle is categorized into mild, moderate, or severe grades depending on the level of cardiac function and the extent of inotrope and mechanical support required. Agreed risk factors for PGD include donor, recipient, and surgical procedural factors. Recommended management involves minimization of risk factors, gradual increase of inotropes, and use of mechanical circulatory support as needed. Retransplantation may be indicated if risk factors are minimal. With a standardized definition of POD, there will be more consistent recognition of this phenomenon and treatment modalities will be more comparable. This should lead to better understanding of PGD and prevention/minimization of its adverse outcomes. (C) 2014 International Society for Heart and Lung Transplantation. All rights reserved.