title: Primary graft failure following lung transplantation: predictive factors of mortality.
abstract: OBJECTIVE
  To assess incidence, outcome, and early predictors of mortality for patients with primary graft failure (PGF) following lung transplantation (LTx), and to develop an injury severity score able to accurately predict ICU mortality for these patients.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Two LTx centers in Paris.
  
  
  METHODS
  Two hundred fifty-nine patients who underwent LTx over a 12-year period.
  
  
  RESULTS
  One hundred thirty-one patients (50.6%) met PGF criteria: radiographic graft infiltrate within the first 3 days following LTx associated with gas exchange impairment (PaO(2)/fraction of inspired oxygen ratio < 300 mm Hg). This syndrome was associated with an increased duration of mechanical ventilation (9.1 +/- 1 days vs 3.1 +/- 0.6 days, mean +/- SD; p < 0.001) and ICU mortality (29% vs 10.9%; p < 0.01). The patients with PGF were randomly assigned to developmental (n = 85) and validation (n = 46) samples. Using logistic regression analysis, four variables were found associated with ICU mortality in these patients: age, degree of gas exchange impairment, graft ischemic time, and severe early hemodynamic failure. An ischemia/reperfusion injury severity score was derived using these four variables. Model calibration was good in the developmental and validation samples, as was model discrimination (area under receiver operating characteristic curves, 0.93 and 0.85, respectively).
  
  
  CONCLUSIONS
  PGF following LTx is a frequent event, with significant ICU morbidity and mortality. We demonstrate that four simple factors allow prediction of ICU mortality with good accuracy.
authors.affiliation: Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, Clichy, France. gabreil.thabut@bjn.ap-hop-paris.fr
authors.forename: Gabriel
authors.initials: G
authors.lastname: Thabut
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vinatier
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Stern
authors.forename: Guy
authors.initials: G
authors.lastname: Lesèche
authors.forename: Philippe
authors.initials: P
authors.lastname: Loirat
authors.forename: Michel
authors.initials: M
authors.lastname: Fournier
authors.forename: Hervé
authors.initials: H
authors.lastname: Mal
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015427:Reperfusion Injury / Q000209:etiology* / Q000401:mortality*; D012189:Retrospective Studies; D017211:Treatment Failure