Primary Graft Dysfunction after Heart Transplantation: Current Evidence and Implications for Clinical Practice.

Purpose of review: This review summarizes the current literature on primary graft dysfunction highlighting the current definition, reviewing epidemiology, and describing donor, recipient, and perioperative risk factors in the contemporary era.

Recent findings: PGD, in its most severe form, complicates 8% of heart transplants and portends a 1-year mortality of close to 40%. PGD is multifactorial and heterogeneous with contributions from donor and recipient risk as well as organ recovery and preservation modalities. Biomarkers may enhance risk stratification and lend insight into the underlying mechanism of PGD. Temperature-controlled storage and hypothermic oxygenation perfusion systems, in particular, may have significant potential to mitigate PGD risk. PGD is a devastating early complication of heart transplantation that is both complex and multifactorial. Despite its incidence and impact the underlying biology of PGD remains poorly understood. Future studies mechanistic studies are needed to address the underlying pathophysiology of PGD to develop targeted prophylactic and/or therapeutic interventions.