Trends in primary graft dysfunction and early mortality following lung transplantation: A single center experience

Although the long-term prognosis after lung transplantation has improved recently, primary graft dysfunction (PGD) remains the major cause of early mortality. The aim of this study was to elucidate trends in PGD incidence and short-term mortality following lung transplantation in the contemporary era.

We analyzed a single-center database of lung transplantations performed across three periods (Era 1: 2009-2013, Era 2: 2014-2017, and Era 3: 2018-2021). PGD was graded according to the 2016 International Society for Heart and Lung Transplantation definition, and PGD grade 3 within T0-T72 was used as the primary outcome. Trends in PGD incidence, factors associated with PGD, and early mortality rates after lung transplantation were identified.

This study included 856 lung transplants: 277 in Era 1, 296 in Era 2, and 283 in Era 3. PGD grade 3 incidence decreased significantly over time: 35.9% (99 cases) in Era 1, 26.4% (78 cases) in Era 2, and 18.4% (52 cases) in Era 3 (P<0.001). During the study period, the lung allocation score (LAS) and intraoperative cardiopulmonary bypass (CPB) use decreased, whereas the use of intraoperative nitric oxide and extracorporeal membrane oxygenation increased. Logistic multivariate modeling identified era, recipient sex (male), underlying disease, race, and blood transfusion as factors associated with PGD. No significant difference was observed in 30-day hospital mortality across the three eras (2.9%, 1.4%, and 1.4% for Era 1, Era 2, and Era 3, respectively; P=0.313).

This study demonstrated a significant reduction in PGD incidence over time, which coincided with a decrease in LAS and intraoperative CPB use. However, no significant changes were observed in short-term mortality after lung transplantation.