Clinical risk factors for primary graft dysfunction after lung transplantation

Joshua M. Diamond, James C. Lee, Steven M. Kawut, Rupal J. Shah, A. Russell Localio, Scarlett L. Bellamy, David J. Lederer, Edward Cantu, Benjamin A. Kohl, Vibha N. Lama, Sangeeta M. Bhorade, Maria Crespo, Ejigayehu Demissie, Joshua Sonett, Keith Wille, Jonathan Orens, Ashish S. Shah, Ann Weinacker, Selim Arcasoy, Pali D. ShahDavid S. Wilkes, Lorraine B. Ware, Scott M. Palmer, Jason D. Christie

Research output: Contribution to journalArticlepeer-review

319 Scopus citations


Rationale: Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors. Objectives: We sought to identify donor, recipient, and perioperative risk factors for PGD. Methods: Weperformeda 10-center prospective cohort studyenrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was International Society for Heart and Lung Transplantation grade 3 PGD at 48 or 72 hours post-transplant. The association of potential risk factors with PGD was analyzed using multivariable conditional logistic regression. Measurements and Main Results: A total of 1,255 patients from10 centers were enrolled; 211 subjects (16.8%) developed grade 3 PGD. In multivariable models, independent risk factors for PGD were any history of donor smoking (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.6; P = 0.002); FIO2 during allograft reperfusion (OR, 1.1 per 10% increase in FIO2; 95% CI, 1.0-1.2; P = 0.01); single lung transplant (OR, 2; 95%CI, 1.2-3.3;P=0.008);use of cardiopulmonary bypass(OR,3.4;95%CI, 2.2-5.3; P < 0.001); overweight (OR, 1.8; 95% CI, 1.2-2.7; P = 0.01) and obese (OR, 2.3; 95% CI, 1.3-3.9; P = 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1-5.6; P = 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6-7.7; P = 0.002); and mean pulmonary artery pressure (OR, 1.3 per 10 mm Hg increase; 95%CI, 1.1-1.5;P < 0.001).PGD was significantly associated with 90-day (relative risk, 4.8; absolute risk increase, 18%; P < 0.001) and 1-year (relative risk, 3; absolute risk increase, 23%; P < 0.001) mortality. Conclusions: We identified grade 3 PGD risk factors, several of which are potentially modifiable and should be prioritized for future research aimed at preventative strategies.

Original languageEnglish (US)
Pages (from-to)527-534
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Issue number5
StatePublished - Mar 1 2013


  • Clinical risk factors
  • Lung transplantation
  • Primary graft dysfunction

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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