title: Clinical risk factors for primary graft dysfunction in a low-volume lung transplantation center.
abstract: Primary graft dysfunction (PGD) is a severe acute lung injury syndrome following lung transplantation. Previous studies of clinical risk factors, including a multicenter prospective cohort trial, have identified a number of recipient, donor, and operative variables related to Grade 3 PGD. The aim of this study was to validate these risk factors in a lung transplantation center with a low volume of procedures. We conducted a retrospective cohort study of 45 consecutive lung transplantations performed between January 2011 and September 2013. PGD was defined according to the International Society for Heart and Lung Transplantation grading scale. Risk factors were evaluated independently and the significant confounders entered into multivariable logistic regression models. The overall incidence of Grade 3 PGD was 35.5% at T24, 17.7% at T48, and 15.5% at T72. The following risk factors were associated with Grade 3 PGD at the indicated time points: recipient female gender at T24 (P=.034), mixed diagnoses at T72 (P=.047), ECMO bridge-to-lung transplantation at T24 (P=.0004) and at T48 (P=.038), donor causes of death different from stroke and trauma at T24 (P=.019) and T72 (P=.014), blood transfusions during surgery at T24 (P=.001), intraoperative venoarterial ECMO T24 (P<.0001). Multivariate analysis at T24 identified recipient female gender and intraoperative venoarterial ECMO as risk factors (P=.010 and P=.018, respectively). This study demonstrated that risk factors for severe PGD in a low-volume center were similar to international reports in prevalence and type. ECMO bridge-to-lung transplantation emerged as a risk factor previously underestimated.
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, Foundation IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital-University of Milan, Milan, Italy. Electronic address: mario.nosotti@unimi.it.
authors.forename: M
authors.initials: M
authors.lastname: Nosotti
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, Foundation IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital-University of Milan, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Palleschi
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, Foundation IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital-University of Milan, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Rosso
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, Foundation IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital-University of Milan, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Tosi
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, Foundation IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital-University of Milan, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Mendogni
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, Foundation IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital-University of Milan, Milan, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Righi
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, Foundation IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital-University of Milan, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Montoli
authors.affiliation: Department of Anesthesia and Intensive Care, Foundation IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital-University of Milan, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Crotti
authors.affiliation: Department of Anesthesia and Intensive Care, Foundation IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital-University of Milan, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Russo
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors