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Contemporary Incidence and Risk Factors in Isolated Right Ventricular Primary Graft Dysfunction After Heart Transplantation
Abstract   Peer reviewed

Contemporary Incidence and Risk Factors in Isolated Right Ventricular Primary Graft Dysfunction After Heart Transplantation

P.D. Cho, H. Zappacosta, J. Song, J. White, S. McKay, A. Abramov, M. Daniel, M. Husain and A. Ardehali
The Journal of heart and lung transplantation, v 45(5), pp 89-90
Jul 2026
DOI: https://doi.org/10.1016/j.healun.2026.02.193
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Abstract

Purpose: The national incidence, predictors, and outcomes of isolated right ventricular primary graft dysfunction (RV-PGD) are not well defined. Using the newly available national PGD data, we evaluated the contemporary risk factors and outcomes of RV-PGD following heart transplantation (HT). Methods: We queried the United Network for Organ Sharing database to identify all adult, isolated HTs from 9/2023-6/2025. Recipients were stratified by development of RV-PGD (per 2014 ISHLT consensus definition) vs no RV-PGD (control). Predictors of RV-PGD were identified using a multivariable logistic regression model. Outcomes of interest included renal replacement therapy (RRT), length of hospital stay, and 6-month survival. Kaplan-Meier analysis was conducted to compare 6-month survival following HT between the two groups. Results: A total of 6,857 patients underwent HT, and the national incidence of RV-PGD was 3.7% (n=251). Independent predictors of RV-PGD included recipient body mass index (BMI) (Adjusted Odds Ratio (AOR) 1.04 per 1 kg/m2 rise, 95% Confidence Interval (CI): 1.01-1.07, p=0.004), history of sternotomy (AOR 1.72, 95% CI: 1.26-2.34, p=0.001), donor alkalosis prior to procurement (AOR 1.35, 95% CI: 1.01-1.82, p=0.042), and donor BMI (AOR 0.97 per 1 kg/m2 rise, 95% CI: 0.95-0.99, p=0.012). Recipients with RV-PGD had higher rates of RRT (41.6% vs 18.1%, p<0.001), longer median hospital stay (26 vs 17 days, p<0.001), and lower 6-month survival (Figure). Furthermore, RV-PGD recipients who required mechanical circulatory support (MCS), including extracorporeal membrane oxygenation and right ventricular assist device, had the lowest 6-month survival compared to those with RV-PGD and Control (Figure). Conclusion: Isolated RV-PGD occurs in about 4% of heart transplants and is associated with worse early outcomes, particularly when MCS is required. Optimizing donor respiratory management and considering these risk factors may mitigate the incidence of RV-PGD.

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