Primary Graft Dysfunction is Associated with Increased Radiographic Atelectasis at Three Months Post-Lung Transplant

Purpose Primary graft dysfunction (PGD) contributes to mortality and impaired lung function after lung transplant but little is known about future radiographic manifestations. We assessed radiographic features on 3-month post-transplant chest computed tomography (CT) studies and the association with future risk of baseline lung allograft dysfunction (BLAD) and chronic lung allograft dysfunction (CLAD). We hypothesized radiographic abnormalities would be more frequent after PGD and be associated with increased risk of BLAD and CLAD. Methods We studied double-lung transplant recipients from 2010-2016. Grade 3 PGD (PGD3) was defined as CXR edema + PaO2/FiO2 80%) and CLAD (ISHLT 2019 definition) using logistic and Cox models respectively. Results 237 patients met inclusion criteria, 50 (21%) of whom developed post-operative PGD3. PGD3 was associated with more frequent and/or widely distributed ILS (p=0.0389) and atelectasis (p Conclusion Grade 3 PGD is associated with radiographic atelectasis at 3-months post-transplant. Atelectasis increases the risk of BLAD but not CLAD. This latter finding is plausible given the injury of PGD is confined to the post-operative period rather than sustained. Post-PGD atelectasis may suggest persistent surfactant/type II pneumocyte dysfunction, but this requires further study.