Vasoplegia following
cardiac transplantation is associated with increased morbidity and mortality. Previous studies have not accounted for
primary graft dysfunction (
PGD). The definition of
vasoplegia is based on pressor requirement at 48 hours, many
PGD parameters may have normalized after the initial 24 hours on inotropes. We surmised that the purported negative effects of
vasoplegia following
transplantation may in part be driven by
PGD. We reviewed 240 consecutive adult cardiac transplants at our center between 2012 and 2016. The severity of
vasoplegia was evaluated as a risk factor for 1-year survival, and the analysis was repeated for the subgroup of 177 patients who did not develop
PGD. Overall, 63 (26%) of patients developed mild, moderate, or severe
PGD. In those without
PGD,
vasoplegia was associated with
length of stay but not with short- or long-term mortality. Moderate and/or severe
vasoplegia occurred in 35 (15%) patients and was associated with higher short-term mortality,
length of stay, and
PGD. Multivariate logistic regression identified body mass index ≥35 kg/m2, left
ventricular assist device before
transplantation, and use of
extracorporeal membrane oxygenation as joint risk factors for
vasoplegia. In patients without
PGD, only left
ventricular assist device before
transplantation was associated with
vasoplegia. In conclusion, our results show that, in the sizeable subgroup of patients with no signs of
PGD,
vasoplegia had a much more modest impact on post-transplant morbidity and no significant effect on 1- and 3-year survival. This suggests that
PGD may be a confounder when assessing
vasoplegia as a risk factor for adverse outcomes.