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Impact of Immediate Primary Lung Allograft Dysfunction on Bronchiolitis Obliterans Syndrome

¹ Division of Pulmonary and Critical Care and ² Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri

Correspondence and requests for reprints should be addressed to Ramsey R. Hachem, M.D., Washington University School of Medicine, Division of Pulmonary and Critical Care, 660 S. Euclid Avenue, Campus Box 8052, St. Louis, MO 63110. E-mail: rhachem{at}im.wustl.edu

Rationale: Primary graft dysfunction is a common complication after lung transplantation and a significant risk factor for short- and long-term mortality.

Objective: We examined the impact of primary graft dysfunction on bronchiolitis obliterans syndrome.

Methods: We performed a retrospective cohort study of 334 adult lung transplant recipients at our program and graded the severity of primary graft dysfunction according to the International Society for Heart and Lung Transplantation definition. We evaluated the impact of primary graft dysfunction on acute rejection, lymphocytic bronchitis, and bronchiolitis obliterans syndrome stage 1, using univariable and multivariable Cox proportional hazards models.

Main Results: Among the 334 recipients, 65 did not have primary graft dysfunction (grade 0), 130 had grade 1, 69 had grade 2, and 70 had grade 3. In the univariable analysis, all grades of primary graft dysfunction were associated with a significantly increased risk of bronchiolitis obliterans syndrome stage 1 (grade 1: relative risk [RR] = 1.73; grade 2: RR = 2.13; and grade 3: RR = 2.53, compared with grade 0). The multivariable model demonstrated that the increased risk of bronchiolitis obliterans syndrome associated with primary graft dysfunction was independent of acute rejection, lymphocytic bronchitis, and community-acquired respiratory viral infections. However, there was no association between primary graft dysfunction and acute rejection or lymphocytic bronchitis.

Conclusions: Primary graft dysfunction is associated with an increased risk of bronchiolitis obliterans syndrome independent of acute rejection, lymphocytic bronchitis, and community-acquired respiratory viral infections, and this risk is directly related to the severity of primary graft dysfunction.

Key Words: lung transplantation • primary graft dysfunction • bronchiolitis obliterans syndrome

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject There are conflicting results on the association of primary graft dysfunction after lung transplantation with an increased risk of bronchiolitis obliterans syndrome. What This Study Adds to the Field Primary graft dysfunction is associated with an increased risk of bronchiolitis obliterans syndrome. This risk is directly related to the severity of primary graft dysfunction.

 

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