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Eur J Cardiothorac Surg 2007;31:75-82. doi:10.1016/j.ejcts.2006.10.024
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
a Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
b Division of Lung Transplantation, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
c Department of Thoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
d Department of Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
e Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Received 15 August 2006; received in revised form 18 October 2006; accepted 23 October 2006.
* Corresponding author. Address: Hjertecentret 2141, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark. Tel.: +45 35 45 29 06; fax: +45 35 45 26 48. (Email: cmburton{at}doctors.net.uk).
Objective: Primary graft dysfunction (PGD) causes significant mortality and morbidity after lung transplantation. The objectives of the study were to describe the clinical and histological sequelae of PGD. Methods: Histology of all patients receiving single-lung transplantation 1999–2004 (n = 181) was reviewed. PGD was defined as diffuse radiological infiltration of the lung allograft occurring within the first 72 h postoperatively. Results: One patient died intra-operatively. PGD was recorded in 63% (n = 113) of 180 consecutive transplant recipients. Patients with PGD had a worse 90-day postoperative mortality (14% versus 3%, p = 0.03) and 3-year survival (55% versus 77%, p = 0.003). Freedom from bronchiolitis obliterans syndrome was similar in both groups. The maximal FEV1 was significantly lower in patients with PGD, median 54% (quartiles 48–61%) predicted; compared to patients without PGD, median 59% (quartiles 54–69%) predicted (p = 0.003). There was a significant linear trend in the decline of maximal FEV1 with the presence and increasing severity of radiographic infiltrate (p = 0.004). During follow-up, patients with PGD were more likely to demonstrate diffuse alveolar damage or bronchiolitis obliterans organizing pneumonia (p = 0.009 and p = 0.01, respectively). Histological findings of diffuse alveolar damage correlated closely with extent of radiological infiltration (p < 0.0001). Conclusions: Transplant recipient survival, lung function, and histological findings of diffuse alveolar damage appear to be closely correlated with the appearance and severity of PGD.
Key Words: Lung transplantation • Primary graft dysfunction • Diffuse alveolar damage • Bronchiolitis obliterans organizing pneumonia • Acute cellular rejection • Bronchiolitis obliterans syndrome
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