The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2026
Primary graft dysfunction after lung transplant in mechanically ventilated versus extubated patients.
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Petrovic Mark, Auner Sophia, Dörflinger Amalia B, Tiller Felix, Adjei Enock, Eidson Christian, Le Luan, Boyce William, Schweiger Thomas, Muraközy Gabriella, Aigner Clemens, Jaksch Peter, Demarest Caitlin T, Trindade Anil J, Shaver Ciara M, Stokes John W, Wilkins Alexis, Bacchetta Matthew, Benazzo Alberto, Hoetzenecker Konrad, Schwarz Stefan
Аннотация
BACKGROUND: Primary graft dysfunction grading is an important prognostic parameter following lung transplantation. Because the current ISHLT consensus classification does not differentiate between mechanically ventilated and extubated patients, we examined whether mechanical ventilation status influences the prognostic value of PGD grades for short- and long-term outcomes.
METHODS: All primary bilateral lung transplants performed at the Medical University of Vienna and Vanderbilt University Medical Center (January 2017 - December 2024) were retrospectively analyzed. PGD was adjudicated per the 2016 ISHLT Consensus Statement. At each postoperative time point (T24, T48, T72), patients were stratified by PGD grade and ventilation status. ICU-free and hospital-free days were compared using Bonferroni-corrected Wilcoxon rank-sum tests. Long-term survival was assessed using Kaplan-Meier analysis and Cox models adjusted for PGD grade, center, donor and recipient age, sex, diagnosis, and ECMO bridge-to-transplant.
RESULTS: Among 1022 patients, 311 (30.4%) were extubated by T24, 560 (54.8%) by T48, and 651 (63.7%) by T72. Extubated patients had more ICU-free and hospital-free days across most PGD grades and time points. Kaplan-Meier analysis demonstrated significantly better survival for extubated patients among PGD 0/1 at all time points and PGD 2/3 at T24 and T48. After multivariable adjustment, mechanical ventilation was independently associated with worse survival among PGD 0/1 at T72 (HR 1.56, 95% CI: 1.12-2.16) and PGD 2/3 at T48 (HR 2.68, 95% CI: 1.20-5.98). The association within PGD2/3 at T72 did not reach statistical significance.
CONCLUSIONS: Mechanical ventilation status carries prognostic information not captured by the current PGD grade. Within PGD0/1 at 72 h, the largest subgroup in the cohort, mechanical ventilation was independently associated with worse long-term survival, a finding that replicated at both centers. Future PGD classification revisions should include ventilatory status to improve prognostic accuracy.
METHODS: All primary bilateral lung transplants performed at the Medical University of Vienna and Vanderbilt University Medical Center (January 2017 - December 2024) were retrospectively analyzed. PGD was adjudicated per the 2016 ISHLT Consensus Statement. At each postoperative time point (T24, T48, T72), patients were stratified by PGD grade and ventilation status. ICU-free and hospital-free days were compared using Bonferroni-corrected Wilcoxon rank-sum tests. Long-term survival was assessed using Kaplan-Meier analysis and Cox models adjusted for PGD grade, center, donor and recipient age, sex, diagnosis, and ECMO bridge-to-transplant.
RESULTS: Among 1022 patients, 311 (30.4%) were extubated by T24, 560 (54.8%) by T48, and 651 (63.7%) by T72. Extubated patients had more ICU-free and hospital-free days across most PGD grades and time points. Kaplan-Meier analysis demonstrated significantly better survival for extubated patients among PGD 0/1 at all time points and PGD 2/3 at T24 and T48. After multivariable adjustment, mechanical ventilation was independently associated with worse survival among PGD 0/1 at T72 (HR 1.56, 95% CI: 1.12-2.16) and PGD 2/3 at T48 (HR 2.68, 95% CI: 1.20-5.98). The association within PGD2/3 at T72 did not reach statistical significance.
CONCLUSIONS: Mechanical ventilation status carries prognostic information not captured by the current PGD grade. Within PGD0/1 at 72 h, the largest subgroup in the cohort, mechanical ventilation was independently associated with worse long-term survival, a finding that replicated at both centers. Future PGD classification revisions should include ventilatory status to improve prognostic accuracy.