Allograft dysfunction is the major cause of early morbidity and mortality following cardiac transplantation. Poor graft function can be secondary to transplant complications or, when no identifiable cause is present, primary graft dysfunction (PGD). To standardize the definition of PGD, a consensus conference was convened which produced a document that defines severity categories and criteria for assessing left and right ventricular dysfunction. A critical sub-criterion in the consensus definition of PGD is a score intended to reflect the need for inotropic support after transplant. However, during the Australian and New Zealand trial of Hypothermic Oxygenated Perfusion preservation of donor hearts, we realized that the consensus inotrope score was inflated by the disproportionate impact of norepinephrine (NE), upcoding PGD grades from mild to moderate. A review of 50 heart transplant patients at The Alfred Hospital showed that in 38% of the instances when the inotropic score exceeded the consensus cutoff value due to NE, there was no identifiable PGD or vasoplegia and in 16% of instances, the cutoff was exceeded due to vasoplegia without PGD. Given the importance of accurate PGD classification in an era when static cold storage preservation is being replaced by machine perfusion and temperature controlled static storage, we contend that NE should be removed from the inotrope score equation to prevent up coding of mild to moderate PGD. Furthermore, we think that PGD classification should incorporate sensitive load- independent cardiac performance measures in the context of given levels of pharmacological and mechanical cardiac support.

中文翻译：

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正性肌力药评分用作原发性移植物功能障碍的衡量标准。


同种异体移植物功能障碍是心脏移植术后早期发病率和死亡率的主要原因。移植物功能差可能继发于移植并发症，或者当不存在可识别的原因时，原发性移植物功能障碍 （PGD）。为了标准化 PGD 的定义，召开了一次共识会议，该会议制定了一份文件，定义了评估左心室和右心室功能障碍的严重程度类别和标准。PGD 共识定义中的一个关键子标准是旨在反映移植后对正性肌力药物支持的需求的评分。然而，在澳大利亚和新西兰对供体心脏的低温氧合灌注保存试验期间，我们意识到去甲肾上腺素 （NE） 的不成比例的影响夸大了共识正性肌力评分，将 PGD 等级从轻度上调为中度。对阿尔弗雷德医院 50 名心脏移植患者的回顾表明，在 38% 的正性肌力评分超过 NE 的共识临界值的情况下，没有可识别的 PGD 或血管麻痹，在 16% 的情况下，由于血管麻痹而超过临界值没有 PGD。鉴于准确的 PGD 分类在静态冷藏保存被机器灌注和温控静态储存所取代的时代的重要性，我们认为应该从正性肌力药物评分方程中删除 NE，以防止轻度至中度 PGD 的编码升级。此外，我们认为 PGD 分类应在给定水平的药物和机械心脏支持的情况下纳入敏感负荷无关的心脏功能测量。