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Published ahead of print on March 11, 2005, doi:10.1164/rccm.200409-1243OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 11, June 2005, 1312-1316

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Submitted on September 20, 2004
Accepted on March 3, 2005

The Effect of Primary Graft Dysfunction on Survival Following Lung Transplantation

Jason D Christie1*, Robert M Kotloff2, Vivek N Ahya2, Gregory Tino2, Alberto Pochettino3, Christina Gaughan4, Ejigayehu DeMissie2, and Stephen E Kimmel5

1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA, 2 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA, 3 Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA, 4 Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA, 5 Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

* To whom correspondence should be addressed. E-mail: jchristi{at}cceb.med.upenn.edu.

Rationale: Primary graft dysfunction is a severe acute lung injury syndrome following 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 5262 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; and to assess potential bias from the effects of early mortality, we also evaluated subjects who survived at least one 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 thirty days was 42.1% for primary graft dysfunction versus 6.1% in patients without [relative risk = 6.95 (95% CI 5.98, 8.08) p<0.001]; and among subjects who died by 30 days, 43.6% had primary graft dysfunction. Among patients surviving at least one 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 following lung transplantation. Survivors of primary graft dysfunction have increased risk of death extending beyond the first posttransplant year.
Key words: Primary Graft Dysfunction, Reperfusion Injury, Lung Transplantation, Complications, Acute Lung Injury, Outcomes




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