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(Chest. 1998;114:51-60.)
© 1998 American College of Chest Physicians

Primary Graft Failure Following Lung Transplantation

Jason D. Christie MD1; Joseph E. Bavaria MD2; Harold I. Palevsky MD, FCCP1; Leslie Litzky MD3; Nancy P. Blumenthal CRNP1; Larry R. Kaiser MD, FCCP2; and Robert M. Kotloff MD, FCCP1

1 From the Pulmonary and Critical Care Division, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia
2 From the Division of General Thoracic Surgery, Department of Surgery, University of Pennsylvania Medical Center, Philadelphia
3 From the Division of General Thoracic Surgery, and the Department of Pathology, University of Pennsylvania Medical Center, Philadelphia

Study objectives: To determine the incidence of primary graft failure (PGF) following lung transplantation, assess possible risk factors, and characterize its effect on outcomes.

Methods: Retrospective review of 100 consecutive patients undergoing lung transplantation at the University of Pennsylvania Medical Center. Fifteen patients meeting diagnostic criteria for PGF (PGF+ group) were compared with 85 patients without this complication (PGFminus group).

Results: The incidence of PGF was 15%. There was no significant difference in age, sex, underlying pulmonary disease, preoperative pulmonary artery systolic pressure, type of transplant, allograft ischemic times, use of cardiopulmonary bypass, or use of postoperative prostaglandin E1 infusion between the PGF+ and PGFminus groups. Induction therapy with antilymphocyte globulin was used less frequently in the PGF+ group (p<0.005). Duration of mechanical ventilatory support was 36±43 days vs 4±6 days for the PGF+ and PGFminus groups, respectively (p<0.0001). Hospital stay was significantly longer in the PGF+ group, averaging 75±105 days, compared with 27±38 days in the PGF group (p<0.005). One-year actuarial survival for the PGF+ group was only 40% compared with 69% for the PGFminus group (p<0.005). Five of the six PGF+ survivors were ambulatory by 1 year; three were completely independent while two continued to require assistance with activities of daily living. Six-minute walk test distance among the ambulatory patients averaged 883±463 feet (range, 200 to 1,223 feet) compared with 1513±424 feet for the PGFminus group (p<0.005). Among the subset of survivors who underwent single lung transplantation for COPD, the mean percent predicted FEV1 at 1 year was 43% for the PGF+ group and 55% for the PGFminus groups, but this difference was not statistically significant.

Conclusions: PGF is a devastating postoperative complication, occuring in 15% of patients in the current series, and it is associated with a high mortality rate, lengthy hospitalization, and protracted and often compromised recovery among survivors.

Key Words: complications • graft dysfunction • lung transplantation • reperfusion injury • respiratory failure

Submitted on October 2, 1997
Accepted on December 8, 1997




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