title: The role of donor chronic alcohol abuse in the development of primary graft dysfunction in lung transplant recipients.
abstract: Primary graft dysfunction (PGD) following lung transplantation is clinically similar to the acute respiratory distress syndrome. Because alcohol abuse independently increases the incidence of acute respiratory distress syndrome in at-risk individuals, we hypothesized that donor alcohol use is correlated with an increased risk of PGD. As a pilot study, we collected alcohol use histories using a validated instrument, the Alcohol Use Disorder Identification Test questionnaire, from 74 donors and correlated these with the development of PGD in corresponding recipients. Nineteen percent (14/74) of donors were classified as heavy alcohol users, as defined by the Alcohol Use Disorder Identification Test scores≥8. In the 1st 4 days post-transplantation, similar percentages of recipients developed grade 3 PGD on at least 1 day (heavy alcohol user=29% [4/14] versus lighter alcohol user=27% [16/60]); however, recipients receiving a lung from a heavy alcohol user were more likely to have multiple and consecutive days of grade 3 PGD, especially in the 1st 48 hours post-transplant. Both median length of stay in the intensive care unit and hospital were somewhat longer in the heavy alcohol user group (9 versus 7 days and 19.5 versus 17.5 days, respectively). If these preliminary findings are validated in a multi-center study, they would have important implications not only for our understanding of the pathophysiology of PGD but also for the development of novel treatments based on the evolving evidence from experimental and clinical studies on how alcohol abuse renders the lung susceptible to acute edematous injury.
authors.affiliation: Division of Pulmonary & Critical Care and the Florida Hospital Heart/Lung Transplant Programs (AP), Orlando, Florida; Division of Pulmonary, Allergy and Critical Care Medicine (POM, NSS, DMG), Emory University, Atlanta, Georgia; Atlanta Veterans Affairs Medical Center (POM, DMG), Decatur, Georgia; Division of Cardiothoracic Surgery (SDF), Emory University, Atlanta, Georgia; Department of Biostatistics and Bioinformatics (LE), Rollins School of Public Health, Emory University, Atlanta, Georgia; and Department of Pediatrics (LASB), Emory University, Atlanta, Georgia.
authors.forename: Andres
authors.initials: A
authors.lastname: Pelaez
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Mitchell
authors.forename: Nimesh S
authors.initials: NS
authors.lastname: Shah
authors.forename: Seth D
authors.initials: SD
authors.lastname: Force
authors.forename: Lisa
authors.initials: L
authors.lastname: Elon
authors.forename: Lou Ann S
authors.initials: LA
authors.lastname: Brown
authors.forename: David M
authors.initials: DM
authors.lastname: Guidot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism; D002648:Child; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000209:etiology*; D011795:Surveys and Questionnaires; D014019:Tissue Donors