Report of the International Society for Heart and Lung Transplantation Working Group on Primary Lung Graft Dysfunction, part II: Epidemiology, risk factors, and outcomes—A 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation

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Primary Graft Dysfunction Incidence

In the early days of lung transplantation, the incidence of primary graft dysfunction (PGD) was difficult to assess accurately, with a range from 15% to 57%, partly as a result of varying definitions.1, 2, 3, 4 Despite the development of the International Society for Heart and Lung Transplantation (ISHLT) consensus statement defining PGD in 2005, the incidence of PGD in lung transplant recipients still depends on the severity grade and timing of grading for the PGD phenotype being evaluated.

Recipient risk factors

The identification of recipient-related risk factors associated with PGD is of great clinical importance. Since the last ISHLT consensus document from 2005, a number of studies have been designed and published, which have extended our knowledge.8, 11, 12, 13, 14, 15, 16, 17, 18, 19

Donor risk factors

Recent studies have refined our understanding of donor-specific risk factors for PGD. The evidence base has confirmed previous observations, whereas other suspected risk factors have been refuted (Table 1). There is also an expanding body of knowledge on donor management techniques that affect organ availability and recipient outcomes in both the adult and pediatric populations.25, 26, 27, 28

Prior cardiothoracic surgery

A single-center study found prior cardiothoracic surgery was not associated with an increased risk of PGD.66 However, when the incidence of PGD was evaluated according to type of prior procedure, the incidence of PGD was higher in the sub-group with previous pleurodesis (8.7%) than in the group without previous pleurodesis (3.1%). The pleural procedures group also had the highest incidence of re-exploration for bleeding, phrenic nerve injury, and other respiratory complications.

Type of transplant

The data on the

PGD-related outcomes

Before the standard clinical definition of PGD was created in 2005 by the ISHLT consensus report,73 the data pertaining to PGD and survival were sparse. There were no data on long-term lung function and only 1 study of functional data showing a decreased 6-minute walk distance and limited ambulatory status in a small group of PGD survivors.74 Other data revealed comparable survival in patients with and without PGD when early mortality was excluded.75

Long-term outcomes

Survival data consist of studies reporting outcomes at 1, 2, 3, 5, and/or 10 years after PGD and those reporting outcomes of 90-day or 1-year PGD survivors.

Functional outcomes

Only one single-center study evaluated the functional outcomes after PGD. At 12 months after transplant, significantly fewer PGD survivors achieved a normal age-appropriate 6-minute walk distance compared with survivors without PGD, and the median best walk distance among PGD survivors was significantly lower than among survivors without PGD.74

Disclosure statement

Selim Arcasoy has served as a consultant for Transmedics and has received research grant funding from Therakos, CMS, and XVivo. None of the other authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

The authors thank Patricia J. Erwin, Lead Reference Librarian at the Mayo Clinic Libraries, for her invaluable assistance with extensive literature searches and review.

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    A list of the International Society for Heart and Lung Transplantation Primary Graft Dysfunction Working Group Members can be found in the online version of this article at www.jhltonline.org.

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