title: Risk factors and outcome of primary graft dysfunction after lung transplantation in Korea.
abstract: BACKGROUND
  Primary graft dysfunction (PGD) is a severe, acute and post-transplantation lung injury associated with early morbidity and mortality. We aimed to identify clinical risk factors for PGD, as well as the outcome of PGD after lung transplantation in Korea.
  
  
  METHODS
  We retrospectively analyzed lung transplant patients in a South Korean Hospital. The primary outcome was grade 3 PGD, defined according to the International Society for Heart and Lung Transplantation criteria. We compared grade 0-2 PGD group to grade 3 PGD group to identify the risk factors and outcome of grade 3 PGD.
  
  
  RESULTS
  Sixty-one patients were enrolled; 16 (26.2%) developed grade 3 PGD. Univariate analysis revealed higher body mass index (BMI) and history of smoking, extracorporeal membrane oxygenation (ECMO) before transplantation in recipients, and an extended intraoperative ischemic time as risk factors for grade 3 PGD. In multivariate analysis, independent risk factors for PGD were higher BMI in recipients [odds ratio (OR), 1.286; P=0.043] and total intraoperative ischemic time (OR, 1.028; P=0.007). As compared to grade 0-2 PGD, grade 3 PGD was significantly associated with a higher re-operation rate (grade 0-2 PGDvs. grade 3 PGD, 22.2%vs. 50.0%; P=0.036), prolonged ventilator apply (median: 6.0vs. 14.5 days; P=0.044), a longer intensive care unit stay (median: 9.0vs. 17.0 days; P=0.041), and a higher rate of renal replacement therapy (RRT) (17.8%vs. 62.5%; P=0.002) after transplantation.
  
  
  CONCLUSIONS
  Patients who developed grade 3 PGD had higher re-operation rate, longer ventilator apply, longer intensive care unit stay, higher rate of RRT, with higher BMI and total intraoperative ischemic time being the significant risk factor. These findings may allow physicians to modify risk factors before development of PGD.
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sungwoo
authors.initials: S
authors.lastname: Moon
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Moo Suk
authors.initials: MS
authors.lastname: Park
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jin Gu
authors.initials: JG
authors.lastname: Lee
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ji Ye
authors.initials: JY
authors.lastname: Jung
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Ae
authors.initials: YA
authors.lastname: Kang
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Sam
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Se Kyu
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Joon
authors.initials: J
authors.lastname: Chang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyo Chae
authors.initials: HC
authors.lastname: Paik
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Song Yee
authors.initials: SY
authors.lastname: Kim
keywords: Primary graft dysfunction (PGD); lung transplantation; outcome; risk factor