Primary graft dysfunction after lung transplant in mechanically ventilated versus extubated patients

Area of Science:

• Thoracic surgery
• Transplantation immunology
• Critical care medicine

Background:

• Primary graft dysfunction (PGD) grading is crucial for lung transplant prognosis.
• Current ISHLT PGD classification lacks differentiation between ventilated and extubated patients.
• Mechanical ventilation status may influence PGD's prognostic value.

Purpose of the Study:

• To investigate if mechanical ventilation status affects the prognostic significance of PGD grades.
• To evaluate the impact of ventilation status on short- and long-term outcomes after lung transplantation.

Main Methods:

• Retrospective analysis of bilateral lung transplants (2017-2024) from two centers.
• PGD adjudicated per 2016 ISHLT Consensus Statement.
• Patients stratified by PGD grade and ventilation status at T24, T48, T72.
• ICU/hospital-free days compared; long-term survival assessed using Kaplan-Meier and Cox models.

Main Results:

• Extubated patients generally had more ICU/hospital-free days.
• Better survival observed in extubated patients with PGD 0/1 (all time points) and PGD 2/3 (T24, T48).
• Mechanical ventilation independently associated with worse survival in PGD 0/1 at T72 (HR 1.56) and PGD 2/3 at T48 (HR 2.68).

Conclusions:

• Ventilatory status provides prognostic information beyond current PGD grading.
• Mechanical ventilation is linked to worse long-term survival, especially in PGD 0/1 at 72 hours.
• Future PGD classifications should incorporate ventilatory status to enhance prognostic accuracy.