Creating a multivariable model to predict primary graft dysfunction after heart transplantation in the United Kingdom using the 2014 International Society of Heart and Lung Transplantation consensus definition

Abstract

Heart failure places a global strain on healthcare provision. It has an increasing incidence and represents the endpoint of a variety of cardiovascular diseases. The preceding decades have carved out a clear management algorithm for the use of pharmacotherapies (neurohormonal antagonists), device-based therapies (Implantable Cardioverting Defibrillator (ICD) and Cardiac Resynchronisation Therapy (CRT)) and mechanical therapies including left ventricular assist devices and heart transplantation. While heart transplantation remains the gold standard for the suitable few, the advancement of healthcare systems and improved working conditions and safety regulations have changed the demographics of the typical organ donor which traditionally were young brainstem death donors (DBD) with minimal other comorbidities. Nevertheless, transplantation confers a substantial survival benefit for selected patients with advanced heart failure, achieving a 1-year survival rate of ≥80%. The primary cause for early mortality in recipients remains primary graft dysfunction (PGD). The incidence of PGD throughout the UK and the world are variable due to the lack of a standardised definition until 2014. My research explored the true incidence of PGD throughout the UK using data collected from each of the 6 transplant centres alongside the National Health Service Blood and Transplant database. I then looked at risk factors for PGD which culminated in the largest PGD study recorded at the time of writing. I also looked into the role of mechanical circulatory support to bridge patients in cardiogenic shock post-myocardial infarction in Scotland. I finally developed 2 scoring systems, 1 for Primary Graft Dysfunction (PREDICTA) and 1 using the modified Delphi Method of a consensus agreement (GTS) to factor in elements of frailty which had been garnering increasing interest at conferences I had attended