Predictors of Grade 3 Primary Graft Dysfunction in Lung Transplant Recipients

Abstract

<h3>Purpose</h3> Primary graft dysfunction (PGD) remains a feared complication and contributes to significant morbidity and mortality following lung transplantation. The goal of this study was to evaluate factors associated with grade 3 PGD at a large volume lung transplant center. <h3>Methods</h3> We conducted retrospective review of all adult lung transplant recipients performed at University of California Los Angeles from January 1999 to August 2021, including data on donor and recipient baseline characteristics, laboratory values, and operative variables. The primary outcome was grade 3 PGD at 48 or 72 hours after lung transplantation. Donor and recipient factors associated with grade 3 PGD were examined with multivariable logistic regression. <h3>Results</h3> Of 1230 lung transplants performed during the study period with adequate PGD data, grade 3 PGD at 48 or 72 hours occurred in 86(7.0%) recipients. Recipients who developed grade 3 PGD were less likely male(49% vs 60%, p<0.04), white(56% vs 69%, p=0.04), and diagnosis groups A(15% vs 21%, p<0.01) and C (1% vs 5%, p<0.01). They were more likely to be diabetic(31% vs 22%, p=0.04), receive double lungs(65% vs 53%, p=0.04), and be completed on cardiopulmonary bypass(76% vs 64%, p=0.04). Recipients who developed grade 3 PGD also had higher BMI(27±4 vs 25±4 kg/m², p<0.01), PA pressures (50±21 vs 41±16 mmHg systolic and 21±10 vs 18±8 mmHg diastolic, p<0.01) and longer ischemic times (5.4±1.7 vs 4.7±1.3 hours, p<0.01). The grade 3 PGD group also had a lower proportion of male donors(52% vs 66%, p<0.01). On multivariable logistic regression, factors associated with increased odds of grade 3 PGD were recipient BMI (aOR 1.11, 95% CI 1.04-1.17), increasing PA systolic pressure (aOR 1.02 per mmHg, 95% CI 1.01-1.03), and increasing ischemic time (aOR 1.40 per hr, 95% CI 1.19-1.64). Male donors (aOR 0.49, 95% CI 0.30-0.79) were associated with lower odds of grade 3 PGD. The c-statistic for the multivariable model was 0.73. <h3>Conclusion</h3> Increasing recipient BMI, PA systolic pressures, and ischemic time were associated with developing grade 3 PGD 48 or 72 hours after lung transplantation, whereas male donors were protective in our single center study. These variables may help inform donor and recipient selection to reduce the risk of PGD following lung transplantation.