Management of Primary Graft Dysfunction and Vasoplegia Syndromes

Primary graft dysfunction (PGD), a complication that may occur in the immediate postoperative period following cardiac transplantation, manifests as severe ventricular dysfunction and carries significant morbidity and mortality. Vasoplegia syndrome, a postsurgical phenomenon following cardiac surgery characterized by preserved cardiac output, decreased systemic vascular resistance, and hypotension can similarly complicate the early post-transplantation clinical course. Prompt recognition of PGD and vasoplegic syndrome is essential to minimize morbidity and mortality of cardiac transplant recipients. This chapter delineates the risk factors for the development of these conditions as well as parameters for the diagnoses of graft dysfunction and vasoplegic syndrome. PGD presents on a spectrum characterized by visually impaired graft function and distorted hemodynamics in the absence of secondary causes, e.g. acute rejection or pulmonary hypertension. Factors associated with the development of PGD can be separated into three categories: recipient, donor, or procedure.