Contemporary trends in PGD incidence, outcomes, and therapies

Edward Cantu, Joshua M. Diamond, Marisa Cevasco, Yoshi Suzuki, Maria Crespo, Emily Clausen, Laura Dallara, Christian V. Ramon, Michael T. Harmon, Christian Bermudez, Luke Benvenuto, Michaela Anderson, Keith M. Wille, Ann Weinacker, Gundeep S. Dhillon, Jonathan Orens, Pali Shah, Christian Merlo, Vibha Lama, John McDyerLaurie Snyder, Scott Palmer, Matt Hartwig, Chadi A. Hage, Jonathan Singer, Carolyn Calfee, Jasleen Kukreja, John R. Greenland, Lorraine B. Ware, Russel Localio, Jesse Hsu, Robert Gallop, Jason D. Christie

Research output: Contribution to journalArticlepeer-review


Background: We sought to describe trends in extracorporeal membrane oxygenation (ECMO) use, and define the impact on PGD incidence and early mortality in lung transplantation. Methods: Patients were enrolled from August 2011 to June 2018 at 10 transplant centers in the multi-center Lung Transplant Outcomes Group prospective cohort study. PGD was defined as Grade 3 at 48 or 72 hours, based on the 2016 PGD ISHLT guidelines. Logistic regression and survival models were used to contrast between group effects for event (i.e., PGD and Death) and time-to-event (i.e., death, extubation, discharge) outcomes respectively. Both modeling frameworks accommodate the inclusion of potential confounders. Results: A total of 1,528 subjects were enrolled with a 25.7% incidence of PGD. Annual PGD incidence (14.3%-38.2%, p = .0002), median LAS (38.0-47.7 p = .009) and the use of ECMO salvage for PGD (5.7%-20.9%, p = .007) increased over the course of the study. PGD was associated with increased 1 year mortality (OR 1.7 [95% C.I. 1.2, 2.3], p = .0001). Bridging strategies were not associated with increased mortality compared to non-bridged patients (p = .66); however, salvage ECMO for PGD was significantly associated with increased mortality (OR 1.9 [1.3, 2.7], p = .0007). Restricted mean survival time comparison at 1-year demonstrated 84.1 days lost in venoarterial salvaged recipients with PGD when compared to those without PGD (ratio 1.3 [1.1, 1.5]) and 27.2 days for venovenous with PGD (ratio 1.1 [1.0, 1.4]). Conclusions: PGD incidence continues to rise in modern transplant practice paralleled by significant increases in recipient severity of illness. Bridging strategies have increased but did not affect PGD incidence or mortality. PGD remains highly associated with mortality and is increasingly treated with salvage ECMO.

Original languageEnglish (US)
Pages (from-to)1839-1849
Number of pages11
JournalJournal of Heart and Lung Transplantation
Issue number12
StatePublished - Dec 2022


  • ECMO
  • bridge to transplant
  • lung transplantation
  • outcomes and lung allocation score
  • primary graft dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Transplantation
  • Pulmonary and Respiratory Medicine
  • Surgery


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