primary graft dysfunction PGD risk factors

Risk factors, both proven and postulated, for the development of PGD can be divided into donor, recipient, intraoperative, and postoperative factors.

For the donor, these include age extremes older than 55 years, African American race, smoking history, alcohol use, donor aspiration, donor head or chest trauma, prolonged mechanical ventilation, inhalational smoke exposure, hemodynamic instability after brain death, and massive donor blood transfusion.

Recipient risk factors include diseases with secondary pulmonary hypertension, idiopathic pulmonary fibrosis, pulmonary arterial hypertension, sarcoidosis, obesity (BMI >25 kg/mg2), female sex, elevated pulmonary artery pressures at time of transplant, and left ventricular diastolic dysfunction.

Perioperative risk factors include FIO2 greater than 0.4 during allograft reperfusion, single lung transplant, preformed autoantibodies, use of cardiopulmonary bypass, transfusions greater than 1 L, prolonged ischemic times, prolonged anastomotic times, not using lung protective ventilation, and delayed chest closure.

Risk factors after lung transplant include aspiration, volume overload, arterial and venous anastomotic complications, hemodynamic instability, mechanical ventilation with large tidal volumes, and pneumonia.1234567

Footnotes

  1. SEEK Questionnaires ↩

  2. Cantu E, Diamond JM, Cevasco M, et al. Contemporary trends in PGD incidence, outcomes, and therapies. J Heart Lung Transplant. 2022;41(12):1839-1849. PubMed ↩

  3. Diamond JM, Arcasoy S, Kennedy CC, et al. Report of the International Society for Heart and Lung Transplantation Working Group on Primary Lung Graft Dysfunction, part II: epidemiology, risk factors, and outcomes-a 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2017;36(10):1104-1113. PubMed ↩

  4. Harano T, Ryan JP, Morrell MR, et al. Extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation. ASAIO J. 2021;67(9):1071-1078. PubMed ↩

  5. Natalini JG, Clausen ES. Critical care management of the lung transplant recipient. Clin Chest Med. 2023;44(1):105-119. PubMed ↩

  6. Natalini JG, Diamond JM. Primary graft dysfunction. Semin Respir Crit Care Med. 2021;42(3):368-379. PubMed ↩

  7. Snell GI, Yusen RD, Weill D, et al. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction, part I: definition and grading-a 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2017;36(10):1097-1103. PubMed ↩