Primary Graft Dysfunction Increases the Risk of Baseline Lung Allograft Dysfunction but Not Chronic Lung Allograft Dysfunction after Lung Transplantation

Purpose Primary graft dysfunction (PGD) after lung transplantation has been shown to limit survival and increase chronic lung allograft dysfunction (CLAD) risk. The relationship between PGD and baseline lung allograft dysfunction (BLAD), a physiologic state associated with poor survival where graft function fails to normalize, is not known. Our objective was to assess the association between severe PGD, BLAD and CLAD in a single cohort. We hypothesized that PGD survivors would be at increased risk of both CLAD and BLAD. Methods We reviewed all double lung transplant recipients transplanted in our program between 2004 and 2016. We defined grade 3 PGD (PGD3) as lung edema on chest x-ray as interpreted by a radiologist and PaO2/FiO2 ratio Results 446 patients met inclusion criteria. 76 (17%) developed PGD3 at 48- or 72-hours post-transplant. Patients with PGD3 were more likely to have had interstitial lung disease or pulmonary vascular disease and to have higher BMIs and older donors. Those patients with PGD3 more frequently developed BLAD (58% vs. 36%; p=0.0008) and more severe BLAD grades (p Conclusion Severe PGD was associated with increased risk and severity of baseline lung allograft dysfunction (BLAD), but not CLAD. This is plausible, given the injury of PGD is confined to the perioperative period rather than a sustained injury resulting in progressive loss. The mechanisms via which PGD mediate poor baseline function require further investigation.