primary graft dysfunction PGD short and longterm outcomes

• related: lung transplant and complications
• tags: #literature #pulmonology

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The shortand long-term outcomes of PGD correlate with scores at 48 and 72 hours, and the higher grade (PGD 3) and longer duration at 48 to 72 hours of PGD appear to have the worse prognosis and greatest impact on long-term outcomes. In the short term, PGD is associated with increased duration of mechanical ventilation, ICU, and hospital length of stay, hospital resource utilization, and higher costs.

Long-term, PGD is associated with an increased risk of development of the bronchiolitis obliterans syndrome phenotype of CLAD (CLAD chronic lung allograft dysfunction), and with higher grades and longer duration, both 90-day and 1-year mortality (choice A is incorrect). A large multicenter prospective, cohort study in patients with severe PGD at 48 or 72 hours found an unadjusted 90-day mortality rate of 23% vs 5% for those without severe PGD. In another study, 90-day death rates for different grades of PGD were: grade 1= 7%, grade 2 = 12%, and grade 3 = 33%, respectively. Several studies have shown that grade 3 PGD was associated with a greater risk of 1-year all-cause mortality compared with the group without grade 3 PGD. In one study, all-cause mortality at 1 year was 64.9% with PGD 3 >48 hours vs 20.4% in the non-PGD/non-PGD 3 group. In another large study, patients with severe PGD had an increased 90-day mortality (absolute risk of 18%) and an increased 1-year mortality (absolute risk of 23%). There is no clear increase in subsequent acute cellular rejection or infection following PGD. There may be an increased risk of acute humoral or antibody mediated rejection. ^1234567

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• lung transplant and complications

  • primary graft dysfunction PGD short and longterm outcomes

• pulmonary vein thrombosis following lung transplant

  • In the early postoperative period, the differential diagnosis of PVT with pulmonary venous occlusion includes primary graft dysfunction (primary graft dysfunction PGD short and longterm outcomes), acute rejection, and infection. The clinical exam findings of right-sided hemiparesis, head CT imaging with left-sided intracerebral hemorrhage, and the CT imaging of the neck with absent left internal carotid artery blood flow make pulmonary venous outflow obstruction the most likely etiology for her hypoxemic respiratory failure.

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 ↩