title: The effect of primary graft dysfunction on survival after lung transplantation.
abstract: BACKGROUND
  Primary graft dysfunction is a severe acute lung injury syndrome after lung transplantation. Long-term outcomes of subjects with primary graft dysfunction have not been studied.
  
  
  OBJECTIVE
  We sought to test the relationship of primary graft dysfunction with both short- and long-term mortality using a large registry.
  
  
  METHODS
  We used data collected on 5,262 patients in the United Network for Organ Sharing/International Society of Heart and Lung Transplantation registry between 1994 and 2000. We assessed outcomes in all subjects; to assess potential bias from the effects of early mortality, we also evaluated subjects who survived at least 1 year, using Cox proportional hazards models with time-varying covariates.
  
  
  RESULTS
  The overall incidence of primary graft dysfunction was 10.2% (95% confidence intervals [CI], 9.2, 10.9). The incidence did not vary by year over the period of observation (p = 0.22). All-cause mortality at 30 days was 42.1% for primary graft dysfunction versus 6.1% in patients without graft dysfunction (relative risk = 6.95; 95% CI, 5.98, 8.08; p < 0.001); among subjects who died by 30 days, 43.6% had primary graft dysfunction. Among patients surviving at least 1 year, those who had primary graft dysfunction had significantly worse survival over ensuing years (hazard ratio, 1.35; 95% CI, 1.07, 1.70; p = 0.011). Adjustment for clinical variables including bronchiolitis obliterans syndrome did not change this relationship.
  
  
  CONCLUSIONS
  Primary graft dysfunction contributes to nearly half of the short-term mortality after lung transplantation. Survivors of primary graft dysfunction have increased risk of death extending beyond the first post-transplant year.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, 719 Blockley Hall, Philadelphia, PA 19104, USA. jchristi@cceb.med.upenn.edu
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kotloff
authors.forename: Vivek N
authors.initials: VN
authors.lastname: Ahya
authors.forename: Gregory
authors.initials: G
authors.lastname: Tino
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.forename: Christina
authors.initials: C
authors.lastname: Gaughan
authors.forename: Ejigayehu
authors.initials: E
authors.lastname: DeMissie
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Kimmel
mesh_terms: D002423:Cause of Death; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation / Q000401:mortality*; D012042:Registries; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology