Outcome of lung transplanted patients with primary graft dysfunction

Objective: Primary graft dysfunction (PGD) causes significant mortality and morbidity after lung transplantation. The objectives of the study were to describe the clinical and histological sequelae of PGD. Methods: Histology of all patients receiving singie-lung transplantation 1999-2004 (n = 181) was reviewed. PGD was defined as diffuse radiological infiltration of the lung allograft occurring within the first 72 h postoperatively. Results: One patient died intra-operativety. PGD was recorded in 63% (n = 113) of 180 consecutive transplant recipients. Patients with PGD had a worse 90-day postoperative mortality (14% versus 3%, p = 0.03) and 3-year survival (55% versus 77%, p = 0.003). Freedom from bronchiolitis obliterans syndrome was similar in both groups. The maximal FEV1 was significantly lower in patients with PGD, median 54% (quartiles 48-61%) predicted; compared to patients without PGD, median 59% (quartiles 54-69%) predicted (p = 0.003). There was a significant linear trend in the decline of maximal FEV1, with the presence and increasing severity of radiographic infiltrate (p = 0.004). During follow-up, patients with PGD were more likely to demonstrate diffuse alveolar damage or bronchiolitis obliterans organizing pneumonia (p = 0.009 and p = 0.01, respectively). Histological findings of diffuse alveolar damage correlated closely with extent of radiological infiltration (p < 0.0001). Conclusions: Transplant recipient survival, lung function, and histological findings of diffuse alveolar damage appear to be closely correlated with the appearance and severity of PGD. (c) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. AR rights reserved.