The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2025
Differential outcomes of ISHLT PGD 3 after ex-vivo lung perfusion compared to PGD 3 after direct transplantation.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Benazzo Alberto, Peel John, Mariscal Andrea, Yeung Jonathan, Aversa Meghan, Keshavjee Shaf, Cypel Marcelo
Аннотация
BACKGROUND: Primary graft dysfunction (PGD) remains the most feared complication in the early postoperative period after lung transplantation (LTx). Despite improved evaluation of marginal lungs with ex-vivo lung perfusion (EVLP), PGD 3 is still observed. We aimed to evaluate the outcomes of patients developing PGD 3 after EVLP.
METHODS: This is a retrospective single-center study, including patients who received LTx between 2008 and 2021 in the Toronto Lung Transplant Program. The primary end-point was 90-day mortality. Propensity score weighting was applied to correct for possible confounders.
RESULTS: The final analysis included 1,871 patients, of which 538 lungs were transplanted after EVLP assessment using the Toronto EVLP technique. The incidence of grade 3 PGD was 38.1% and 20.8% (p < 0.001) on intensive care unit (ICU) admission and 13.2% and 12.1% (p = 0.445) at 72 hours for EVLP LTx and standard transplantation, respectively. The EVLP LTx group developing PGD 3 on arrival to ICU had a shorter median length of mechanical ventilation (82 vs 124 hours, p < 0.001), shorter length of stay in ICU (6 vs 12 days, p < 0.001), and shorter length of hospital stay (23 vs 41 days, p < 0.001) compared to standard LTx PGD 3 group. A lower 90-day mortality rate in the EVLP LTx group was observed compared to standard LTx (6% vs 11%, p = 0.078). Mortality rate at 1 year post-transplant for PGD 3 patients was similar between the groups.
CONCLUSIONS: The incidence of PGD 3 on admission to the ICU is higher after EVLP compared to standard transplantation. However, PGD 3 after acellular normothermic EVLP resolves within 24 hours and short-term outcomes are significantly improved compared to patients with PGD 3 after standard transplantation.
METHODS: This is a retrospective single-center study, including patients who received LTx between 2008 and 2021 in the Toronto Lung Transplant Program. The primary end-point was 90-day mortality. Propensity score weighting was applied to correct for possible confounders.
RESULTS: The final analysis included 1,871 patients, of which 538 lungs were transplanted after EVLP assessment using the Toronto EVLP technique. The incidence of grade 3 PGD was 38.1% and 20.8% (p < 0.001) on intensive care unit (ICU) admission and 13.2% and 12.1% (p = 0.445) at 72 hours for EVLP LTx and standard transplantation, respectively. The EVLP LTx group developing PGD 3 on arrival to ICU had a shorter median length of mechanical ventilation (82 vs 124 hours, p < 0.001), shorter length of stay in ICU (6 vs 12 days, p < 0.001), and shorter length of hospital stay (23 vs 41 days, p < 0.001) compared to standard LTx PGD 3 group. A lower 90-day mortality rate in the EVLP LTx group was observed compared to standard LTx (6% vs 11%, p = 0.078). Mortality rate at 1 year post-transplant for PGD 3 patients was similar between the groups.
CONCLUSIONS: The incidence of PGD 3 on admission to the ICU is higher after EVLP compared to standard transplantation. However, PGD 3 after acellular normothermic EVLP resolves within 24 hours and short-term outcomes are significantly improved compared to patients with PGD 3 after standard transplantation.