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Orthotopic Left Lung Transplantation in Rats
Published on: July 3, 2025
673
Interobserver variability impairs radiologic grading of primary graft dysfunction after lung transplantation
Stefan Schwarz1, Moritz Muckenhuber1, Alberto Benazzo1
1Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
The Journal of Thoracic and Cardiovascular Surgery
|June 18, 2019
Summary
Radiologists showed poor agreement when scoring chest radiographs for primary graft dysfunction after lung transplants. This variability significantly impacts the assessment of lung transplant outcomes.
Area of Science:
- Thoracic radiology
- Transplant surgery
- Pulmonary medicine
Background:
- Primary graft dysfunction (PGD) grading after lung transplantation is crucial for patient outcomes.
- Current PGD scoring heavily relies on chest radiograph interpretation, which can be subjective.
Purpose of the Study:
- To evaluate the interobserver variability in scoring postoperative chest radiographs for PGD.
- To assess the impact of this variability on PGD grading in a large lung transplant cohort.
Main Methods:
- Retrospective analysis of 497 lung transplantations.
- Independent review of 1988 postoperative chest radiographs by five thoracic radiologists.
- Calculation of interobserver variability using Fleiss' kappa statistics.
Main Results:
- Only 43% consensus among radiologists across all evaluated radiographs.
- Moderate agreement (κ=0.456) at 0-6 and 24 hours, decreasing to poor agreement (κ=0.405-0.409) at 48-72 hours.
- Significant variation in PGD grade 3 rates (8.4% vs. 28.4% at 0-6 hours) due to interobserver variability. Factors like high BMI and size-reduced transplants increased variability.
Conclusions:
- Substantial interobserver variability in chest radiograph scoring complicates accurate PGD assessment.
- Future PGD grading systems must address this subjectivity to improve reliability and clinical decision-making.
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