Risk factors for early primary graft dysfunction after lung transplantation: a registry study.
ABSTRACT Primary graft dysfunction (PGD) is a leading cause of early morbidity and mortality in lung transplantation. We sought to identify risk factors for PGD using the United Network for Organ Sharing/International Society for Heart and Lung Transplant (UNOS/ISHLT) Registry.
A total of 6984 lung transplants between 1994 and 2002 were available for analysis. Potential risk factors were tested for association with PGD and multivariable logistic regression was applied to adjust for confounding.
The overall incidence of PGD was 10.7% (95% CI 9.9-11.4). In multivariable analyses, factors independently associated with PGD were donor age >45 yr (p < 0.001); donor head trauma (p = 0.03); recipient body mass index >25 kg/m(2) (p = 0.005); recipient female gender (p = 0.001); use of Eurocollins preservation solution (p = 0.001); single lung transplant (p = 0.005); increased ischemic time (p < 0.001); and elevated recipient pulmonary artery systolic pressure at transplant (p < 0.001). Recipient transplant diagnosis was strongly associated with PGD, with primary or secondary pulmonary hypertension (p < 0.001 for both), and idiopathic (p < 0.001) or secondary pulmonary fibrosis (p = 0.011) as significant and independent risk factors for PGD.
Risk factors for PGD in the UNOS/ISHLT registry are consistent with prior smaller studies. Recipient, donor, and therapy variables are independently associated with PGD, as defined in a large registry.
Article: Twinned single-lung transplantation: a privileged model for the study of recipient-dependent factors of outcome.[show abstract] [hide abstract]
ABSTRACT: Lung transplantation is the only life-saving treatment for end-stage respiratory disease. The outcome will depend on the graft quality, surgical conditions and recipient factors. Twinned single-lung transplantation defines as two different recipients treated with lung grafts from the same donor. Recipient-dependent factors of the outcome can be studied more accurately as the graft quality is supposed equal for both recipients. We reviewed all single-lung transplantations performed in France between 1998 and 2008 in the French registry run by the 'Agence de Biomédecine'. Criteria for donor lung quality and twinned recipient data were recorded in a database. The whole medical history and the transplantation outcome were reviewed for each patient and compared with its twin recipient. We compared twins on the basis of their opposed characteristics and on the basis of the opposed endpoint outcome. Endpoints were primary graft dysfunction (PGD) grade III, and mortality at 1, 3 and 12 months. A total of 387 single-lung transplantations were performed in 10 French centres; 180 were twinned recipients from 90 donors. Statistical analysis revealed a significantly different outcome for PGD only. PGD was significantly higher (P < 0.05) in fibrosis recipients compared with emphysema twins. In 28 pairs (31%), the outcome was discordant for PGD, and fibrosis was significantly more often involved compared with emphysema (P = 0.04). Sixty-two pairs had a similar outcome: two pairs showed PGD in both recipients while 60 pairs were free of PGD. We conclude that recipient's disease is a major determinant of the outcome. Fibrosis is associated with an increased risk for PGD.European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 01/2012; 41(6):1357-64; discussion 1364-5. · 2.40 Impact Factor