Donor lung weight a novel predictor for primary graft dysfunction

Primary graft dysfunction (PGD) remains a leading cause of early morbidity and mortality in lung transplantation. PGD is characterized by diffuse alveolar damage and the accumulation of extravascular lung water in the transplanted lung. Pre-existing injury and stress during the donation process are further aggravated by ischemia-reperfusion injury occurring during donation and transplantation. This study examines the relationship between adjusted donor lung weight, a surrogate for extravascular lung water, and outcomes following bilateral lung transplantation.

We retrospectively analyzed 194 bilateral lung transplantations performed between January 2014 and May 2021. Donor lung weights were recorded after procurement, adjusted for body surface area, and categorized into quartiles. The primary outcomes assessed were the incidence of PGD (grades II and III) and duration of intensive care unit (ICU) stay. Secondary outcomes included mechanical ventilation duration, pulmonary function at discharge, and one-year mortality.

The incidence of PGD was significantly higher in the upper 4th quartile group ("high-weight," 22.9%) compared with the three lower quartile groups ("low-weight," 8.9%) (p = .020). Multivariate regression identified adjusted lung weight as an independent risk factor for PGD. The "low-weight" group showed higher rates of early extubation within 72 hours of lung transplantation (90.9% vs 83.0%, p = 0.048) and shorter ICU stays (median 3 vs 5 days, p = 0.026). No significant differences were found in ventilation duration, spirometry values, or 1-year survival.

Adjusted donor lung weight is an independent predictor of PGD, suggesting that higher lung weights contribute to worse early outcomes post-transplant. Incorporating lung weight into donor assessment may improve recipient management and outcomes.