HIGHER DONOR PAO2/FIO2 RATIO APPEARS TO BE ASSOCIATED WITH INCREASED INCIDENCE OF PRIMARY GRAFT DYSFUNCTION IN LUNG TRANSPLANT RECIPIENTS

Abstract

SESSION TITLE: Transplantation Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Severe primary graft dysfunction (PGD) is the most common cause of early mortality in lung transplantation and is a significant risk factor for the development of chronic lung allograft dysfunction. Although numerous risk factors for PGD have been identified, little data exists on the impact of donor mechanical ventilation parameters on the incidence of PGD. Given the detrimental effects of hyperoxia on the pulmonary alveolar epithelium and capillary endothelium, we hypothesized that donor hyperoxia may increase the risk of PGD. METHODS: We reviewed 175 lung transplants performed at our institution from 2012 to 2019. The last reported arterial blood gas and ventilator parameters in the UNOS database were collected. Recipient PGD grade was calculated at 48-72 hours post-transplant. Other transplant variables were collected: intraoperative cardiopulmonary bypass use, donor smoking history, as well as recipient diagnosis and BMI. RESULTS: Mean donor P/F ratio was lower for recipients with PGD grades 0-2 (438±69) vs. PGD grade 3 (469±64.8);p=0.006. There was a significant difference in the mean donor P/F ratio between the extremes, PGD grade 0 (430±65.5) and the PGD grade 3 (469±64.8);p=0.005. Notably, the incidence of PGD grade 3 increased with an increase in the donor P/F ratio, with the highest incidence of PGD grade 3 observed when the P/F ratio was >500 (Fig. 1). Mean donor tidal volume (ml/kg of ideal body weight) was similar among all groups: 8.7, 8.8, 8.9, and 8.4 for PGD 0, 1, 2, or 3, respectively. CONCLUSIONS: Recipients with PGD grade 3 had significantly higher donor P/F ratios than those with PGD grade 0-2. Donor P/F ratio >500 was associated with an increased incidence of PGD grade 3. CLINICAL IMPLICATIONS: This preliminary data suggests that donor hyperoxia may lead to an increased risk for severe PGD. More research is needed to further delineate the effects of donor mechanical ventilation strategies and transplant recipient outcomes. DISCLOSURES: No relevant relationships by Kareem Ahmad, source=Web Response No relevant relationships by Shambhu Aryal, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 Added 06/12/2020 by Anne Brown, source=Web Response, value=Honoraria Advisory Committee Member relationship with Vertex Please note: $1001 - $5000 Added 06/12/2020 by Anne Brown, source=Web Response, value=Honoraria Advisory Committee Member relationship with Promedior Please note: $5001 - $20000 Added 06/12/2020 by Anne Brown, source=Web Response, value=Consulting fee No relevant relationships by Vikramjit Khangoora, source=Web Response Advisory Committee Member relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 04/16/2020 by Christopher King, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Actelion Please note: $5001 - $20000 Added 04/16/2020 by Christopher King, source=Web Response, value=Honoraria Advisory Committee Member relationship with Actelion Please note: $1001 - $5000 Added 04/27/2020 by Christopher King, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Boehringer Ingelheim pharmaceuticals Please note: $1001 - $5000 Added 04/27/2020 by Christopher King, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Actelion Please note: $1001 - $5000 Added 04/27/2020 by Christopher King, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $1001 - $5000 Added 04/27/2020 by Christopher King, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Genentech Please note: $1001 - $5000 Added 04/27/2020 by Christopher King, source=Web Response, value=Honoraria Advisory Committee Member relationship with United therapeutics Please note: $1001 - $5000 Added 04/27/2020 by Christopher King, source=Web Response, value=Consulting fee Consultant relationship with Veracyte Please note: $1001 - $5000 Added 04/03/2020 by Steven Nathan, source=Web Response, value=Honoraria Consultant relationship with United Therapeutics Please note: $5001 - $20000 Added 05/27/2020 by Steven Nathan, source=Web Response, value=Consulting fee Consultant relationship with Bellerophon Please note: $5001 - $20000 Added 05/27/2020 by Steven Nathan, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Roche-Genentech Please note: $5001 - $20000 Added 05/27/2020 by Steven Nathan, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boerhinger-Ingelheim Please note: $20001 - $100000 Added 05/27/2020 by Steven Nathan, source=Web Response, value=Honoraria Scientific Medical Advisor relationship with Johnson & Johnson Please note: $1001 - $5000 Added 04/22/2020 by Oksana Shlobin, source=Web Response, value=Consulting fee Scientific Medical Advisor relationship with Bayer Please note: $1001 - $5000 Added 04/22/2020 by Oksana Shlobin, source=Web Response, value=Grant/Research Support Scientific Medical Advisor relationship with United Therapeutics Please note: $1001 - $5000 Added 04/22/2020 by Oksana Shlobin, source=Web Response, value=Consulting fee