title: Clinical risk factors for primary graft dysfunction after lung transplantation.
abstract: BACKGROUND
  Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors.
  
  
  OBJECTIVE
  We sought to identify donor, recipient, and perioperative risk factors for PGD.
  
  
  METHODS
  We performed a 10-center prospective cohort study enrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was International Society for Heart and Lung Transplantation grade 3 PGD at 48 or 72 hours post-transplant. The association of potential risk factors with PGD was analyzed using multivariable conditional logistic regression.
  
  
  RESULTS
  A total of 1,255 patients from 10 centers were enrolled; 211 subjects (16.8%) developed grade 3 PGD. In multivariable models, independent risk factors for PGD were any history of donor smoking (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.6; P = 0.002); FiO2 during allograft reperfusion (OR, 1.1 per 10% increase in FiO2; 95% CI, 1.0-1.2; P = 0.01); single lung transplant (OR, 2; 95% CI, 1.2-3.3; P = 0.008); use of cardiopulmonary bypass (OR, 3.4; 95% CI, 2.2-5.3; P < 0.001); overweight (OR, 1.8; 95% CI, 1.2-2.7; P = 0.01) and obese (OR, 2.3; 95% CI, 1.3-3.9; P = 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1-5.6; P = 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6-7.7; P = 0.002); and mean pulmonary artery pressure (OR, 1.3 per 10 mm Hg increase; 95% CI, 1.1-1.5; P < 0.001). PGD was significantly associated with 90-day (relative risk, 4.8; absolute risk increase, 18%; P < 0.001) and 1-year (relative risk, 3; absolute risk increase, 23%; P < 0.001) mortality.
  
  
  CONCLUSIONS
  We identified grade 3 PGD risk factors, several of which are potentially modifiable and should be prioritized for future research aimed at preventative strategies. Clinical trial registered with www.clinicaltrials.gov (NCT 00552357).
authors.affiliation: Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA. joshua.diamond@uphs.upenn.edu
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Diamond
authors.forename: James C
authors.initials: JC
authors.lastname: Lee
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kawut
authors.forename: Rupal J
authors.initials: RJ
authors.lastname: Shah
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Bellamy
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
authors.forename: Edward
authors.initials: E
authors.lastname: Cantu
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Kohl
authors.forename: Vibha N
authors.initials: VN
authors.lastname: Lama
authors.forename: Sangeeta M
authors.initials: SM
authors.lastname: Bhorade
authors.forename: Maria
authors.initials: M
authors.lastname: Crespo
authors.forename: Ejigayehu
authors.initials: E
authors.lastname: Demissie
authors.forename: Joshua
authors.initials: J
authors.lastname: Sonett
authors.forename: Keith
authors.initials: K
authors.lastname: Wille
authors.forename: Jonathan
authors.initials: J
authors.lastname: Orens
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Shah
authors.forename: Ann
authors.initials: A
authors.lastname: Weinacker
authors.forename: Selim
authors.initials: S
authors.lastname: Arcasoy
authors.forename: Pali D
authors.initials: PD
authors.lastname: Shah
authors.forename: David S
authors.initials: DS
authors.lastname: Wilkes
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Ware
authors.forename: Scott M
authors.initials: SM
authors.lastname: Palmer
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055031:Primary Graft Dysfunction / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology