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Published ahead of print on March 11, 2005, doi:10.1164/rccm.200409-1243OC
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American Journal of Respiratory and Critical Care Medicine Vol 171. pp. 1312-1316, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200409-1243OC

Original Article

The Effect of Primary Graft Dysfunction on Survival after Lung Transplantation

Jason D. Christie, Robert M. Kotloff, Vivek N. Ahya, Gregory Tino, Alberto Pochettino, Christina Gaughan, Ejigayehu DeMissie and Stephen E. Kimmel

Divisions of Pulmonary and Critical Care Medicine and Cardiovascular Medicine, Department of Medicine; Department of Biostatistics and Epidemiology; and Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Correspondence and requests for reprints should be addressed to Jason D. Christie, M.D., M.S., Assistant Professor of Medicine and Epidemiology, Division of Pulmonary, Allergy, and Critical Care Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, 719 Blockley Hall, Philadelphia, PA 19104. E-mail: jchristi{at}cceb.med.upenn.edu

Rationale: Primary graft dysfunction is a severe acute lung injury syndrome after lung transplantation. Long-term outcomes of subjects with primary graft dysfunction have not been studied. Objectives: We sought to test the relationship of primary graft dysfunction with both short- and long-term mortality using a large registry. Methods: We used data collected on 5,262 patients in the United Network for Organ Sharing/International Society of Heart and Lung Transplantation registry between 1994 and 2000. We assessed outcomes in all subjects; to assess potential bias from the effects of early mortality, we also evaluated subjects who survived at least 1 year, using Cox proportional hazards models with time-varying covariates. Main Results: The overall incidence of primary graft dysfunction was 10.2% (95% confidence intervals [CI], 9.2, 10.9). The incidence did not vary by year over the period of observation (p = 0.22). All-cause mortality at 30 days was 42.1% for primary graft dysfunction versus 6.1% in patients without graft dysfunction (relative risk = 6.95; 95% CI, 5.98, 8.08; p < 0.001); among subjects who died by 30 days, 43.6% had primary graft dysfunction. Among patients surviving at least 1 year, those who had primary graft dysfunction had significantly worse survival over ensuing years (hazard ratio, 1.35; 95% CI, 1.07, 1.70; p = 0.011). Adjustment for clinical variables including bronchiolitis obliterans syndrome did not change this relationship. Conclusion: Primary graft dysfunction contributes to nearly half of the short-term mortality after lung transplantation. Survivors of primary graft dysfunction have increased risk of death extending beyond the first post-transplant year.

Key Words: acute lung injury • lung transplantation • outcomes • primary graft dysfunction • reperfusion injury




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