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
Section snippets
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.
References (101)
- et al.
Management of dysfunction in the transplanted lung: experience with 7 clinical cases. Washington University Lung Transplant Group
Ann Thorac Surg
(1992) - et al.
Acute pulmonary edema after lung transplantation: the pulmonary reimplantation response
Chest
(1999) - et al.
Primary graft failure following lung transplantation
Chest
(1998) - et al.
Risk factors for primary graft dysfunction after lung transplantation
J Thorac Cardiovasc Surg
(2006) - et al.
Validation of the proposed International Society for Heart and Lung Transplantation grading system for primary graft dysfunction after lung transplantation
J Heart Lung Transplant
(2006) - et al.
Short- and long-term outcomes of 1000 adult lung transplant recipients at a single center
J Thorac Cardiovasc Surg
(2011) - et al.
Risk factors and survival impact of primary graft dysfunction after lung transplantation in a single institution
Transplant Proc
(2012) - et al.
Latent class analysis identifies distinct phenotypes of primary graft dysfunction after lung transplantation
Chest
(2013) - et al.
Report of the ISHLT working group on primary lung graft dysfunction part IV: recipient-related risk factors and markers
J Heart Lung Transplant
(2005) - et al.
Elevated plasma Clara cell secretory protein concentration is associated with high-grade primary graft dysfunction
Am J Transplant
(2011)
Elevated pulmonary artery pressure is a risk factor for primary graft dysfunction following lung transplantation for idiopathic pulmonary fibrosis
Chest
Objective estimates improve risk stratification for primary graft dysfunction after lung transplantation
Am J Transplant
Preoperative plasma club (Clara) cell secretory protein levels are associated with primary graft dysfunction after lung transplantation
Am J Transplant
Lung transplantation from donation after cardiocirculatory death: a systematic review and meta-analysis
J Heart Lung Transplant
Extracorporeal membrane oxygenation in pediatric lung transplantation
J Thorac Cardiovasc Surg
Clinical risk factors for primary graft failure following lung transplantation
Chest
Preoperative recipient cytokine levels are associated with early lung allograft dysfunction
Ann Thorac Surg
Effect of an intensive lung donor-management protocol on lung transplantation outcomes
J Heart Lung Transplant
Donor management and lung preservation for lung transplantation
Lancet Respir Med
Early hemodynamic injury during donor brain death determines the severity of primary graft dysfunction after lung transplantation
Am J Transplant
Donation after circulatory death
Br J Anaesth
Excellent clinical outcomes from a national donation-after-determination-of-cardiac-death lung transplant collaborative
Am J Transplant
Lung transplantation with donation after cardiac death donors: long-term follow-up in a single center
J Thorac Cardiovasc Surg
Medium-term outcome after lung transplantation is comparable between brain-dead and cardiac-dead donors
J Heart Lung Transplant
Donation after circulatory determination of death lung transplantation for pulmonary arterial hypertension: passing the toughest test
Am J Transplant
International Society for Heart and Lung Transplantation donation after circulatory death registry report
J Heart Lung Transplant
A decade of living lobar lung transplantation: recipient outcomes
J Thorac Cardiovasc Surg
Lobar lung transplantation from deceased donors: a valid option for small-sized patients with cystic fibrosis
Transplant Proc
Donor age and early graft failure after lung transplantation: a cohort study
Am J Transplant
The registry of the International Society for Heart and Lung Transplantation: nineteenth pediatric lung and heart-lung transplantation report-2016; focus theme: primary diagnostic indications for transplant
J Heart Lung Transplant
The effect of gender combinations on outcome in human lung transplantation: the International Society of Heart and Lung Transplantation registry experience
J Heart Lung Transplant
Lung size mismatch and primary graft dysfunction after bilateral lung transplantation
J Heart Lung Transplant
The role of donor chronic alcohol abuse in the development of primary graft dysfunction in lung transplant recipients
Am J Med Sci
Extended donor criteria in lung transplantation: Impact on organ allocation
J Thorac Cardiovasc Surg
Extended criteria donor lungs and clinical outcome: results of an alternative allocation algorithm
J Heart Lung Transplant
Feasibility and utility of a lung donor score: correlation with early post-transplant outcomes
Ann Thorac Surg
Lung transplantation in patients with prior cardiothoracic surgical procedures
Am J Transplant
Effect of cardiopulmonary bypass on early graft dysfunction in clinical lung transplantation
Ann Thorac Surg
Delayed chest closure after lung transplantation: techniques, outcomes, and strategies
J Heart Lung Transplant
Report of the ISHLT Working Group on Primary Lung Graft Dysfunction part II: definition. A consensus statement of the International Society for Heart and Lung Transplantation
J Heart Lung Transplant
Impact of primary graft failure on outcomes following lung transplantation
Chest
Non-immune acute graft injury after lung transplantation and the risk of subsequent bronchiolitis obliterans syndrome (BOS)
J Heart Lung Transplant
Construct validity of the definition of primary graft dysfunction after lung transplantation
J Heart Lung Transplant
Early trends in PaO(2)/fraction of inspired oxygen ratio predict outcome in lung transplant recipients with severe primary graft dysfunction
Chest
Reperfusion injury significantly impacts clinical outcome after pulmonary transplantation
Ann Thorac Surg
Primary graft failure following lung transplantation: predictive factors of mortality
Chest
Report of the ISHLT Working Group on Primary Lung Graft Dysfunction part V: predictors and outcomes
J Heart Lung Transplant
Report of the ISHLT Working Group on Primary Lung Graft Dysfunction part VI: treatment
J Heart Lung Transplant
Implementation of a management guideline aimed at minimizing the severity of primary graft dysfunction after lung transplant
J Thorac Cardiovasc Surg
Extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation: long-term survival
Ann Thorac Surg
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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.