title: Impact of primary graft failure on outcomes following lung transplantation.
abstract: OBJECTIVE
  Primary graft failure (PGF) is a severe acute lung injury syndrome that occurs following lung transplantation. We compared the clinical outcomes of patients who developed PGF with those who did not.
  
  
  METHODS
  We conducted a retrospective cohort study including 255 consecutive lung transplant procedures. PGF was defined as (1) diffuse alveolar opacities developing within 72 h of transplantation, (2) an arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio of < 200 beyond 48 h postoperatively, and (3) no other secondary cause of graft dysfunction. PGF was tested for acceptance with 30-day and all-cause hospital mortality rates, overall survival, hospital length of stay (HLOS), duration of mechanical ventilation, and best 6-min walk test (6MWT) distance achieved within 12 months.
  
  
  METHODS
  Academic medical center.
  
  
  RESULTS
  The overall incidence of PGF was 11.8% (95% confidence interval [CI], 7.9 to 15.9%). The all-cause mortality rate at 30 days was 63.3% in patients with PGF and 8.8% in patients without PGF (relative risk [RR], 7.15; 95% CI, 4.34 to 11.80%; p < 0.001). A total of 73.3% of patients with PGF died during hospitalization vs 14.2% of patients without PGF (RR, 5.18%; 95% CI, 3.51 to 7.63; p < 0.001). The median HLOS in 30-day survivors was 47 days in patients with PGF vs 15 days in those without PGF (p < 0.001), and the mean duration of mechanical ventilation was 15 days in patients with PGF vs 1 day in those without PGF (p < 0.001). By 12 months, a total of 28.5% of survivors with PGF achieved a normal age-appropriate 6MWT distance vs 71.4% of survivors without PGF at 12 months (p = 0.014). The median best 6MWT distance achieved within the first 12 months was 1,196 feet in patients with PGF vs 1,546 feet in those without PGF (p = 0.009).
  
  
  CONCLUSIONS
  PGF has a significant impact on mortality, HLOS, and duration of mechanical ventilation following lung transplantation. Survivors of PGF have a protracted recovery with impaired physical function up to 1 year following transplantation.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. jchristi@cceb.med.upenn.edu
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Sager
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Kimmel
authors.forename: Vivek N
authors.initials: VN
authors.lastname: Ahya
authors.forename: Christina
authors.initials: C
authors.lastname: Gaughan
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Blumenthal
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kotloff
mesh_terms: D005080:Exercise Test; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome