title: Recipient-related clinical risk factors for primary graft dysfunction after lung transplantation: a systematic review and meta-analysis.
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. Herein, we carried out a systematic review and meta-analysis of published literature to identify recipient-related clinical risk factors associated with PGD development.
  
  
  METHODS
  A systematic search of electronic databases (PubMed, Embase, Web of Science, Cochrane CENTRAL, and Scopus) for studies published from 1970 to 2013 was performed. Cohort, case-control, or cross-sectional studies that examined recipient-related risk factors of PGD were included. The odds ratios (ORs) or mean differences (MDs) were calculated using random-effects models.
  
  
  RESULTS
  Thirteen studies involving 10042 recipients met final inclusion criteria. From the pooled analyses, female gender (OR 1.38, 95% CI 1.09 to 1.75), African American (OR 1.82, 95%CI 1.36 to 2.45), idiopathic pulmonary fibrosis (IPF) (OR 1.78, 95% CI 1.49 to 2.13), sarcoidosis (OR 4.25, 95% CI 1.09 to 16.52), primary pulmonary hypertension (PPH) (OR 3.73, 95%CI 2.16 to 6.46), elevated BMI (BMI≥25 kg/m2) (OR 1.83, 95% CI 1.26 to 2.64), and use of cardiopulmonary bypass (CPB) (OR 2.29, 95%CI 1.43 to 3.65) were significantly associated with increased risk of PGD. Age, cystic fibrosis, secondary pulmonary hypertension (SPH), intra-operative inhaled nitric oxide (NO), or lung transplant type (single or bilateral) were not significantly associated with PGD development (all P>0.05). Moreover, a nearly 4 fold increased risk of short-term mortality was observed in patients with PGD (OR 3.95, 95% CI 2.80 to 5.57).
  
  
  CONCLUSIONS
  Our analysis identified several recipient related risk factors for development of PGD. The identification of higher-risk recipients and further research into the underlying mechanisms may lead to selective therapies aimed at reducing this reperfusion injury.
authors.affiliation: Department of Respiratory Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Respiratory Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Respiratory Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Su
authors.affiliation: Department of Respiratory Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Shu-juan
authors.initials: SJ
authors.lastname: Jiang
mesh_terms: D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000628:therapy; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D009026:Mortality; D016017:Odds Ratio; D063868:Patient Outcome Assessment; D055031:Primary Graft Dysfunction / Q000453:epidemiology* / Q000209:etiology*; D017594:Publication Bias; D011669:Pulmonary Wedge Pressure; D012307:Risk Factors