Background

Primary graft dysfunction (PGD) after lung transplantation has previously been associated with increased risk of death and chronic lung allograft dysfunction (CLAD), but the relationship to baseline lung allograft dysfunction (BLAD), where graft function fails to normalize, is not known.

Methods

We reviewed all double lung transplant recipients transplanted in our program 2004–2016. We defined PGD and CLAD as per recent consensus definitions and BLAD as failure to achieve both FEV1 and FVC ≥80% predicted on 2 consecutive tests ≥3 weeks apart. We used logistic and proportional hazards regression to test the association between severe high-grade PGD (PGD3) with BLAD and CLAD respectively, adjusting for known and identified confounders.

Results

446 patients met inclusion criteria and 76 (17%) developed PGD3 at 48- or 72-h post-transplant. PGD3 occurred more frequently in patients with interstitial lung disease or pulmonary vascular disease, those with higher BMIs and recipients of older donors. PGD3 was associated with more frequent (58% vs. 36%; p = 0.0008) and more severe BLAD (p < 0.0001) and increased BLAD risk in an adjusted model (OR 2.00 [95% CI 1.13–3.60]; p = 0.0182). PGD3 was not associated with CLAD frequency, severity or time to CLAD onset in an adjusted model (HR 1.10 (95% CI 0.64–1.78), p = 0.7226).

Conclusion

Severe PGD was associated with increased risk and severity of BLAD but not CLAD. The mechanisms via which PGD may mediate baseline function warrant further investigation.

中文翻译：

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肺移植后原发性移植物功能障碍幸存者的基线肺移植物功能障碍

背景

肺移植后的原发性移植物功能障碍 (PGD) 与死亡风险增加和慢性同种异体移植物功能障碍 (CLAD) 相关，但与移植物功能未能正常化的基线同种异体移植物功能障碍 (BLAD) 的关系尚不清楚。

方法

我们回顾了 2004-2016 年在我们的计划中移植的所有双肺移植受者。我们根据最近的共识定义将 PGD 和 CLAD 定义为在间隔 ≥ 3 周的 2 次连续测试中未能实现 FEV1 和 FVC ≥ 80% 的预测值。我们使用逻辑和比例风险回归分别测试严重高级 PGD (PGD3) 与 BLAD 和 CLAD 之间的关联，调整已知和已确定的混杂因素。

结果

446 名患者符合纳入标准，76 名（17%）在移植后 48 或 72 小时出现 PGD3。PGD​​3 在间质性肺疾病或肺血管疾病患者、BMI 较高的患者和接受老年供体的患者中更常见。在调整后的模型中，PGD3 与更频繁（58% 对 36%；p = 0.0008）和更严重的 BLAD（p < 0.0001）和增加的 BLAD 风险相关（OR 2.00 [95% CI 1.13–3.60]；p = 0.0182 ）。在调整后的模型中，PGD3 与 CLAD 频率、严重程度或 CLAD 发作时间无关（HR 1.10 (95% CI 0.64–1.78)，p = 0.7226）。

结论

严重的 PGD 与 BLAD 的风险和严重程度增加有关，但与 CLAD 无关。PGD​​ 介导基线功能的机制值得进一步研究。