ISHLT 10-year consensus update: Graft dysfunction within 72 hours after heart transplantation

A 10-year consensus update from the 2024 International Society for Heart and Lung Transplantation (ISHLT) Consensus Conference on graft dysfunction within 72 hours after heart transplantation was published in The Journal of Heart and Lung Transplantation by Kobashigawa et al. The update reassessed the 2013–2014 primary graft dysfunction (PGD) framework and included 16 consensus statements on definitions, grading, risk stratification, and management. 

Key data: Graft dysfunction within 72 hours after heart transplantation should be categorized according to underlying cause and timing. Cases with a known cause should be classified as secondary graft dysfunction (SGD), while cases of unknown cause should be classified as either early graft dysfunction (EGD), replacing PGD, if occurring within 24 hours, or subsequent early graft dysfunction (sEGD) if occurring within 24–72 hours. Severity should be graded as non-severe or severe based on the need for mechanical circulatory support (MCS), replacing inotrope score. The consensus also emphasized comprehensive risk assessment and individualized use of MCS in patients with inadequate response to pharmacologic therapy, with therapeutic plasma exchange and re-transplantation reserved for selected severe/refractory cases. 

Key learning: The updated consensus replaces the PGD framework with EGD/sEGD terminology and MCS-based severity grading, supporting standardized classification and management of graft dysfunction after heart transplantation.