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Rationale: Primary graft dysfunction (PGD) is a form of acute lung injury that occurs after lung transplantation. The definition of PGD was standardized in 2005. Since that time, clinical practice has evolved, and this definition is increasingly used as a primary endpoint for clinical trials; therefore, validation is warranted., Objectives: We sought to determine whether refinements to the 2005 consensus definition could further improve construct validity., Methods: Data from the Lung Transplant Outcomes Group multicenter cohort were used to compare variations on the PGD definition, including alternate oxygenation thresholds, inclusion of additional severity groups, and effects of procedure type and mechanical ventilation. Convergent and divergent validity were compared for mortality prediction and concurrent lung injury biomarker discrimination., Measurements and Main Results: A total of 1,179 subjects from 10 centers were enrolled from 2007 to 2012. Median length of follow-up was 4 years (interquartile range = 2.4-5.9). No mortality differences were noted between no PGD (grade 0) and mild PGD (grade 1). Significantly better mortality discrimination was evident for all definitions using later time points (48, 72, or 48-72 hours; P < 0.001). Biomarker divergent discrimination was superior when collapsing grades 0 and 1. Additional severity grades, use of mechanical ventilation, and transplant procedure type had minimal or no effect on mortality or biomarker discrimination., Conclusions: The PGD consensus definition can be simplified by combining lower PGD grades. Construct validity of grading was present regardless of transplant procedure type or use of mechanical ventilation. Additional severity categories had minimal impact on mortality or biomarker discrimination.

Objective: Donor blood transfusion has been identified as a potential risk factor for primary graft dysfunction and by extension early mortality. We sought to define the contributing risk of donor transfusion on early mortality for lung transplant., Methods: Donor and recipient data were abstracted from the Organ Procurement and Transplantation Network database updated through June 30, 2014, which included 86,398 potential donors and 16,255 transplants. Using the United Network for Organ Sharing 4-level designation of transfusion (no blood, 1-5 units, 6-10 units, and >10 units, massive), we analyzed all-cause mortality at 30-days with the use of logistic regression adjusted for confounders (ischemic time, donor age, recipient diagnosis, lung allocation score and recipient age, and recipient body mass index). Secondary analyses assessed 90-day and 1-year mortality and hospital length of stay., Results: Of the 16,255 recipients transplanted, 8835 (54.35%) donors received at least one transfusion. Among those transfused, 1016 (6.25%) received a massive transfusion, defined as >10 units. Those donors with massive transfusion were most commonly young trauma patients. After adjustment for confounding variables, donor massive transfusion was associated significantly with an increased risk in 30-day (P = .03) and 90-day recipient mortality (P = .01) but not 1-year mortality (P = .09). There was no significant difference in recipient length of stay or hospital-free days with respect to donor transfusion., Conclusions: Massive donor blood transfusion (>10 units) was associated with early recipient mortality after lung transplantation. Conversely, submassive donor transfusion was not associated with increased recipient mortality. The mechanism of increased early mortality in recipients of lungs from massively transfused donors is unclear and needs further study but is consistent with excess mortality seen with primary graft dysfunction in the first 90 days posttransplant., (Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

We sought to compare survival outcomes of lung transplant (LTx) patients after receiving donor lungs with increased or standard risk for exposure to human immunodeficiency (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV). A retrospective review of a single institution database identified patients who received lung transplant from increased risk donor (IRD) or standard risk donor (SRD). Risk category was determined using the Public Health Service (PHS) criteria. The data included 609 lung transplants performed between March 2012 and July 2019. Survival outcomes were compared using Kaplan-Meier curves and log-rank tests. A multivariate Cox proportional hazards model analyzed patient age, sex, BMI, diagnosis, and CPB or ECMO use during surgery. Of the 609 total transplants, 166 (27%) used IRD lungs, and 443 (73%) used SRD lungs. Demographically, the patient population was 66% male, 79% White, 14% Black, 5% Hispanic, and 2% Asian. Recipients' mean age was 64 ± 9.1 and, median BMI 27.6 ± 4.7 kg/m2. IPF was the most common diagnosis, representing 63% of patients, followed by COPD with 24% and sarcoidosis with 4%. Males were significantly more likely to receive an IRD lung (X 2= 7.86, p=0.0051). Additionally, IRD donors were significantly younger than SRD donors (p<0.001). There was no significant association between PHS risk category and patient age, race, BMI, or CPB/ECMO use. For recipients of an IRD lung, survival was 86.5%, 67.5%, and 65.3% at 1 year, 3 years, and 5 years, respectively. For SRD recipients, survival was 86.6% (1 year), 78.7% (3 years), 66.6% (5 years). A log-rank test for equality of survival showed no significant difference between IRD and SRD groups, p=0.089. PHS IRD lungs are an underutilized resource despite showing no decline in survival. This study can improve patient education surrounding the risk of donor derived transmissible disease. [ABSTRACT FROM AUTHOR]

This study sought to compare survival outcomes of lung transplant (LTx) patients who received a lung from a donor after brain death (DBD) or donor after cardiac death (DCD) using institutional data. A single center, retrospective review identified 609 lung transplants performed between March 2012 and July 2019. Because only 14/609 LTx were DCD, DCD recipients were propensity score matched with DBD recipients. Propensity scores (PS) were determined using patient age, sex, race, diagnosis, BMI, CPB or ECMO use during surgery, and donor age. The PS model was verified by comparing 1:1, 1:3, and 1:5 pooled groups, and performing t-tests or chi-square analyses before and after matching. Survival outcomes were determined using Kaplan-Meier curves and log-rank tests. In total, 609 lung transplants were performed at our institution. Of these, 14 received a DCD lung. The mean age of the DCD group was 64.2 (sd = 5.7), and mean BMI was 29.2 kg/m2 (sd = 4.15). Mean donor age for DCD lungs was 31.9 (sd = 14.0). The PS matched DBD group did not significantly differ from the DCD group by age (p = 0.520), sex (p = 0.617), diagnosis (p = 0.414), pump use (p = 0.827), BMI (p = 0.178), or donor age (p = 0.240). For DCD recipients, the 30 day, 90 day, and 1 year survival was 100%, 100%, and 91%, respectively. For DBD recipients, 30 day, 90 day, and 1 year 95.7%, 94.2%, and 83.7%, respectively. A log-rank test of the PS matched data showed no significant difference in survival between DCD and DBD lungs, p=0.372. This finding was consistent across the 1:1, 1:3, and 1:5 PS matched groups. Our experience indicates that DCD and DBD donor lungs provide comparable short-term survival. This finding agrees with other recent results, suggesting DCD donor lungs are a viable alternative and their use can be expanded. [ABSTRACT FROM AUTHOR]