Postreperfusion Pulmonary Artery Pressure Indicates Primary Graft Dysfunction After Lung Transplant

Area of Science:

• Cardiology
• Thoracic Surgery
• Transplantation Medicine

Background:

• Primary graft dysfunction (PGD) is a significant risk factor for early mortality after lung transplantation.
• Current models for identifying patients at high risk for PGD are limited.
• This study investigates postreperfusion systolic pulmonary artery pressure as a potential clinical marker for PGD.

Purpose of the Study:

• To evaluate the association between postreperfusion systolic pulmonary artery pressure and the incidence of primary graft dysfunction after lung transplant.
• To determine if postreperfusion systolic pulmonary artery pressure is a reliable predictor of PGD.
• To compare the predictive value of postreperfusion versus prereperfusion pulmonary artery pressure for PGD.

Main Methods:

• Retrospective review of 158 bilateral lung transplant recipients from January 2020 to July 2022.
• Exclusion of patients who required pretransplant extracorporeal life support.
• Analysis of postreperfusion systolic pulmonary artery pressure in relation to PGD development.

Main Results:

• Primary graft dysfunction occurred in 42.3% of patients.
• Patients with PGD exhibited significantly higher postreperfusion systolic pulmonary artery pressure (41 ± 9.1 mm Hg) compared to those without (31.5 ± 8.8 mm Hg).
• Postreperfusion systolic pulmonary artery pressure was a significant predictor of PGD (OR 1.14, P < .001), with an optimal threshold of 37 mm Hg for prediction (AUC 0.81).

Conclusions:

• Elevated postreperfusion systolic pulmonary artery pressure is predictive of primary graft dysfunction post-lung transplant.
• Postreperfusion systolic pulmonary artery pressure demonstrates superior predictive capability for PGD compared to prereperfusion pressure.
• Utilizing postreperfusion systolic pulmonary artery pressure for early PGD detection can facilitate timely interventions to potentially improve transplant outcomes.