The Effect of Primary Graft Dysfunction on Survival after Lung Transplantation

• DOI: 10.1164/rccm.200409-1243oc
• Publication Date: 2005-03-12T01:26:05Z
• Authors: Jason D. Christie; Robert M. Kotloff; Vivek N. Ahya; Gregory Tino; Alberto Pochettino; Christina Gaughan; Ejigayehu DeMissie; Stephen E. Kimmel
• Keywords: Incidence; Graft Survival; Survival Analysis; United States; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Cause of Death; Humans; Registries; Survivors; Lung Transplantation

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.We sought to test the relationship of primary graft dysfunction with both short- and long-term mortality using a large registry.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.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.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.