Аналіз частоти виникнення первинної дисфункції графта та ідентифікації її предикторів у найбільшій в Україні когорті реципієнтів серця

The aim – to determine the incidence of primary graft dysfunction (PGD) and its phenotypes in the largest national cohort of heart recipients and to identify independent predictors of PGD and in-hospital mortality.Materials and methods. A retrospective one-center cohort study of 111 consecutive orthotopic HTs (2019-2024) was conducted. Donor, recipient, and procedural variables were evaluated; PGD was classified according to the ISHLT-2014 consensus. Univariate analysis was performed by nonparametric and exact tests; independent predictors were identified by stepwise logistic regression (p < 0.05).Results. PGD occurred in 38 patients (34 %), including PGD of right ventricle (RV) – 17 %, PGD of left ventricle (LV) – 10 %, biventricular form – 7 %. The most powerful predictor of all phenotypes was a high value of the Vasoactive inotrope score (VIS) in the donor: every +10 points increased the risk of PGD by 1.34 times (p < 0.001). Preoperative inotropic support of the recipient increased the risk of any PGD threefold (p = 0.0004), and ECMO bridging increased the risk of PGD 5-6 times for bi- and left ventricular phenotypes (p ≤ 0.041). Ischemic time and «undersizing» (< 0.9) were significant for PGD of LV and PGD of RV, respectively. Pre-HT ECMO (aOR ≈ 58), high donor VIS value (aOR ≈ 8.7), and recipient diabetes mellitus (aOR ≈ 1.8) were identified as independent predictors of in-hospital mortality.Conclusions. The incidence of PGD in the Ukrainian cohort is consistent with global data, but the right ventricular form is more common. The leading modifiable risk factor is a high donor VIS; the key recipient determinants are inotropic dependence and ECMO bridging. Optimization of the donor pharmacologic load, accurate mass selection and early biventricular support of recipients may reduce the burden of PGD and early mortality.