Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

TLDR

Primary graft dysfunction is the leading cause of early morbidity and mortality after lung transplantation. The study aimed to identify donor, recipient, and perioperative risk factors for primary graft dysfunction after lung transplantation. A 10‑center prospective cohort of 1,255 patients was analyzed with multivariable conditional logistic regression to assess risk factors for grade 3 PGD within 48–72 hours post‑transplant. Independent risk factors for grade 3 PGD included donor smoking history, high FiO2 during reperfusion, single‑lung transplant, cardiopulmonary bypass, overweight or obesity, sarcoidosis, pulmonary arterial hypertension, and elevated mean pulmonary artery pressure, and PGD was associated with higher 90‑day and 1‑year mortality. The trial is registered at ClinicalTrials.gov (NCT00552357).

Abstract

Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors.We sought to identify donor, recipient, and perioperative risk factors for PGD.We performed a 10-center prospective cohort study enrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was International Society for Heart and Lung Transplantation grade 3 PGD at 48 or 72 hours post-transplant. The association of potential risk factors with PGD was analyzed using multivariable conditional logistic regression.A total of 1,255 patients from 10 centers were enrolled; 211 subjects (16.8%) developed grade 3 PGD. In multivariable models, independent risk factors for PGD were any history of donor smoking (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.6; P = 0.002); FiO2 during allograft reperfusion (OR, 1.1 per 10% increase in FiO2; 95% CI, 1.0-1.2; P = 0.01); single lung transplant (OR, 2; 95% CI, 1.2-3.3; P = 0.008); use of cardiopulmonary bypass (OR, 3.4; 95% CI, 2.2-5.3; P < 0.001); overweight (OR, 1.8; 95% CI, 1.2-2.7; P = 0.01) and obese (OR, 2.3; 95% CI, 1.3-3.9; P = 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1-5.6; P = 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6-7.7; P = 0.002); and mean pulmonary artery pressure (OR, 1.3 per 10 mm Hg increase; 95% CI, 1.1-1.5; P < 0.001). PGD was significantly associated with 90-day (relative risk, 4.8; absolute risk increase, 18%; P < 0.001) and 1-year (relative risk, 3; absolute risk increase, 23%; P < 0.001) mortality.We identified grade 3 PGD risk factors, several of which are potentially modifiable and should be prioritized for future research aimed at preventative strategies. Clinical trial registered with www.clinicaltrials.gov (NCT 00552357).