title: Risk factors and survival impact of primary graft dysfunction after lung transplantation in a single institution.
abstract: BACKGROUND
  Lung transplantation has become a standard procedure for some end-stage lung diseases, but primary graft dysfunction (PGD) is an inherent problem that impacts early and late outcomes. The aim of this study was to define the incidence, risk factors, and impact of mechanical ventilation time on mortality rates among a retrospective cohort of lung transplantations performed in a single institution.
  
  
  METHODS
  We performed a retrospective study of 118 lung transplantations performed between January 2003 and July 2010. The most severe form of PGD (grade III) as defined at 48 and 72 hours was examined for risk factors by multivariable logistic regression models using donor, recipient, and transplant variables.
  
  
  RESULTS
  The overall incidence of PGD at 48 hours was 19.8%, and 15.4% at 72 hours. According multivariate analysis, risk factors associated with PGD were donor smoking history for 48 hours (adjusted odds ratio [OR], 4.83; 95% confidence interval [CI], 1.236-18.896; P = .022) and older donors for 72 hours (adjusted OR, 1.046; 95% CI, 0.997-1.098; P = .022). The operative mortality was 52.9% among patients with PGD versus 20.3% at 48 hours (P = .012). At 72 hours, the mortality rate was 58.3% versus 21.2% (P = .013). The 90-days mortality was also higher among patients with PGD. The mechanical ventilation time was longer in patients with PGD III at 48 hours namely, a mean time of 72 versus 24 hours (P = .001). When PGD was defined at 72 hours, the mean ventilation time was even longer, namely 151 versus 24 hours (P < .001). The mean overall survival for patients who developed PGD at 48 hours was 490.9 versus 1665.5 days for subjects without PGD (P = .001). Considering PGD only at 72 hours, the mean survival was 177.7 days for the PGD group and 1628.9 days for the other patients (P < .001).
  
  
  CONCLUSIONS
  PGD showed an important impacts on operative and 90-day mortality rates, mechanical ventilation time, and overall survival among lung transplant patients. PGD at 72 hours was a better predictor of lung transplant outcomes than at 48 hours. The use of donors with a smoking history or of advanced age were risk factors for the development of PGD.
authors.affiliation: Lung Transplant Group, Thoracic Surgery Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil. marcos.samano@incor.usp.br
authors.forename: M N
authors.initials: MN
authors.lastname: Samano
authors.forename: L M
authors.initials: LM
authors.lastname: Fernandes
authors.forename: J C B
authors.initials: JC
authors.lastname: Baranauskas
authors.forename: A T
authors.initials: AT
authors.lastname: Correia
authors.forename: J E
authors.initials: JE
authors.lastname: Afonso
authors.forename: R H O B
authors.initials: RH
authors.lastname: Teixeira
authors.forename: M L
authors.initials: ML
authors.lastname: Caramori
authors.forename: P M
authors.initials: PM
authors.lastname: Pêgo-Fernandes
authors.forename: F B
authors.initials: FB
authors.lastname: Jatene
mesh_terms: D000328:Adult; D000367:Age Factors; D001938:Brazil / Q000453:epidemiology; D046148:Donor Selection; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D055031:Primary Graft Dysfunction / Q000453:epidemiology* / Q000401:mortality; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D016896:Treatment Outcome; D055815:Young Adult