Primary graft failure following lung transplantation: predictive factors of mortality.
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.
Thabut
Gabriel
G
Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, Clichy, France. gabreil.thabut@bjn.ap-hop-paris.fr
Vinatier
Isabelle
I
Stern
Jean-Baptiste
JB
Lesèche
Guy
G
Loirat
Philippe
P
Fournier
Michel
M
Mal
Hervé
H
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