Abstract
BackgroundPrimary 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. Herein, we carried out a systematic review and meta-analysis of published literature to identify recipient-related clinical risk factors associated with PGD development.MethodA systematic search of electronic databases (PubMed, Embase, Web of Science, Cochrane CENTRAL, and Scopus) for studies published from 1970 to 2013 was performed. Cohort, case-control, or cross-sectional studies that examined recipient-related risk factors of PGD were included. The odds ratios (ORs) or mean differences (MDs) were calculated using random-effects modelsResultThirteen studies involving 10042 recipients met final inclusion criteria. From the pooled analyses, female gender (OR 1.38, 95% CI 1.09 to 1.75), African American (OR 1.82, 95%CI 1.36 to 2.45), idiopathic pulmonary fibrosis (IPF) (OR 1.78, 95% CI 1.49 to 2.13), sarcoidosis (OR 4.25, 95% CI 1.09 to 16.52), primary pulmonary hypertension (PPH) (OR 3.73, 95%CI 2.16 to 6.46), elevated BMI (BMI≥25 kg/m2) (OR 1.83, 95% CI 1.26 to 2.64), and use of cardiopulmonary bypass (CPB) (OR 2.29, 95%CI 1.43 to 3.65) were significantly associated with increased risk of PGD. Age, cystic fibrosis, secondary pulmonary hypertension (SPH), intra-operative inhaled nitric oxide (NO), or lung transplant type (single or bilateral) were not significantly associated with PGD development (all P>0.05). Moreover, a nearly 4 fold increased risk of short-term mortality was observed in patients with PGD (OR 3.95, 95% CI 2.80 to 5.57).ConclusionsOur analysis identified several recipient related risk factors for development of PGD. The identification of higher-risk recipients and further research into the underlying mechanisms may lead to selective therapies aimed at reducing this reperfusion injury.
Highlights
Lung transplantation has become an increasingly common procedure in recent years, it has consistently lagged behind other organs in survival rates [1], and early postoperative allograft dysfunction remains a significant cause of post-transplantation morbidity and mortality [2]
Female gender, African American, idiopathic pulmonary fibrosis (IPF), sarcoidosis, primary pulmonary hypertension (PPH), elevated body mass index (BMI) (BMI$25 kg/m2), and use of cardiopulmonary bypass (CPB) were significantly associated with increased risk of Primary graft dysfunction (PGD)
Primary graft dysfunction (PGD) is a severe form of acute lung injury induced by ischemiareperfusion injury that occurs in approximately 10–25% of lung graft recipients [2,3]
Summary
Lung transplantation has become an increasingly common procedure in recent years, it has consistently lagged behind other organs in survival rates [1], and early postoperative allograft dysfunction remains a significant cause of post-transplantation morbidity and mortality [2]. A number of previous studies have been designed to identify the clinical risk factors associated with PGD [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23] This field is of great clinical interest, since better understanding those transplant recipients most at risk might revolve around a concept of earlier detection for targeted therapy and aggressive support. In this regard, a number of clinical risk factors have been identified, including both organ donor and recipient characteristics. We carried out a systematic review and metaanalysis of published literature to identify recipient-related clinical risk factors associated with PGD development
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