title: Impact of immediate primary lung allograft dysfunction on bronchiolitis obliterans syndrome.
abstract: BACKGROUND
  Primary graft dysfunction is a common complication after lung transplantation and a significant risk factor for short- and long-term mortality.
  
  
  OBJECTIVE
  We examined the impact of primary graft dysfunction on bronchiolitis obliterans syndrome.
  
  
  METHODS
  We performed a retrospective cohort study of 334 adult lung transplant recipients at our program and graded the severity of primary graft dysfunction according to the International Society for Heart and Lung Transplantation definition. We evaluated the impact of primary graft dysfunction on acute rejection, lymphocytic bronchitis, and bronchiolitis obliterans syndrome stage 1, using univariable and multivariable Cox proportional hazards models.
  
  
  RESULTS
  Among the 334 recipients, 65 did not have primary graft dysfunction (grade 0), 130 had grade 1, 69 had grade 2, and 70 had grade 3. In the univariable analysis, all grades of primary graft dysfunction were associated with a significantly increased risk of bronchiolitis obliterans syndrome stage 1 (grade 1: relative risk [RR] = 1.73; grade 2: RR = 2.13; and grade 3: RR = 2.53, compared with grade 0). The multivariable model demonstrated that the increased risk of bronchiolitis obliterans syndrome associated with primary graft dysfunction was independent of acute rejection, lymphocytic bronchitis, and community-acquired respiratory viral infections. However, there was no association between primary graft dysfunction and acute rejection or lymphocytic bronchitis.
  
  
  CONCLUSIONS
  Primary graft dysfunction is associated with an increased risk of bronchiolitis obliterans syndrome independent of acute rejection, lymphocytic bronchitis, and community-acquired respiratory viral infections, and this risk is directly related to the severity of primary graft dysfunction.
authors.affiliation: Division of Pulmonary and Critical Care, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8052, St. Louis, MO 63110, USA.
authors.forename: Shiraz A
authors.initials: SA
authors.lastname: Daud
authors.forename: Roger D
authors.initials: RD
authors.lastname: Yusen
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
authors.forename: Murali M
authors.initials: MM
authors.lastname: Chakinala
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Walter
authors.forename: Aviva A
authors.initials: AA
authors.lastname: Aloush
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Patterson
authors.forename: Elbert P
authors.initials: EP
authors.lastname: Trulock
authors.forename: Ramsey R
authors.initials: RR
authors.lastname: Hachem
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000209:etiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000150:complications* / Q000401:mortality / Q000473:pathology; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013577:Syndrome; D014184:Transplantation, Homologous