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Early Graft Failure After Heart Transplantation: Prevention and Treatment

Early cardiac allograft failure in the transplanted heart is an unfortunate event and could happen due to several reasons. Pulmonary hypertension in the recipient can result in right heart dysfunction in the transplanted heart, which is not accustomed to such high after load. Acute and hyperacute rejection and technical procedural issues such as pulmonary artery kinking can also cause early allograft failure. Donor heart ischemia-reperfusion injury during the transplantation process can result in primary graft dysfunction. Ischemia-reperfusion injury has multifactorial causes; several donor, recipient, and procedure related factors have been identified to predict primary graft dysfunction. The incidence of primary graft dysfunction and early allograft failure seem to be increasing, as marginal donors are accepted for transplantation due to organ shortage and the intention to transplant sick alternate list heart failure candidates, who will have higher mortality with medical treatment alone. Graft failure prevention is the best option since treatment is not highly successful; however, mechanical circulatory support and retransplantation seem helpful in few patients.