Risk Factors Of Primary Graft Dysfunction After Lung Transplantation

Primary Graft Dysfunction is a common complication after lung transplantation,developing in the first 72 hours after lung allograft implantation,presented as hypoxemia and thoracic imaging shows pulmonary edema.The typical histopathologic pattern of PGD is diffuse alveolar damage;however,the pathogenesis of PGD remains unclear now.The morbidity of PGD is around 10 to 30 percent among leading transplant centers.The inconsistency of the definition of PGD caused the variety of the morbidity.The mortality of PGD,up to 50 percent,is a vital factor that infects the prognosis of lung transplantation.There are not any effective prevention and treatment of PGD;the diagnosis is relatively difficult.PGD has now become one of the most challenging problem after lung transplantation.The immediate priority is to deliberate the pathogeny and risk factors of PGD.OBJECTIVETo probe the characteristic and risk factors of PGD after lung transplantation in China.To provide theoretical basis for early prevention,early diagnosis and prognosis of PGD.MATERIALS AND METHODSCollect the data of patients who received lung transplantation from July 2018 to March 2020 in both The First Affiliated Hospital of Zhengzhou University and Sichuan Provincial People's Hospital.Set patients with PGD as the incidence group,the other patients as control group.Compare the data between the two groups,including general characteristics,original diseases,type of surgeries,mean pulmonary artery pressure,PaO2/FiO2 ratio(P/F),duration of operation,infusion volume during surgery,blood transfusion volume during surgery,cold ischemia time of donor lung,Extracorporeal Membrane Oxygenation(ECMO)usage during surgery,3-day P/F after surgery,and donor related information.Analyze the data and seek for the risk factors of PGD.The quantitative data that fit normal distribution were expressed with mean ± standard deviation((?))and t test was used to analyze,quantitative data that do not fit normal distribution were expressed with median and interquartile range[M(P25,P75)],correction of ?2 test and Fisher accurate probability test were used to analyze qualitative data,binary logistic regression was used in multi-factor analysis.RESULT47 patients were analyzed in this study,11 of them developed PGD.There are no statistical differences observed in recipient general characteristics,original diseases,type of surgeries,PaO2/FiO2 ratios,duration of operation,infusion volume during surgery,cold ischemia time of donor lung,ECMO usage during surgery,and donor age,donor lung P/F,and 3-day P/F after surgery between affected and non-affected group(p>0.05).Mean pulmonary artery pressure,blood transfusion volume during surgery and donor smoking proportion in affected group is statistically higher than non-affected group(p<0.05).Binary logistic regression analysis for PGD risk factors shows that higher pulmonary artery pressure and higher blood transfusion volume during surgery are independent risk factors of PGD.CONCLUSION1.Recipients with higher mean pulmonary artery pressure,blood transfusion during surgery and donor smoking history are more prone to develop into PGD.2.Higher pulmonary artery pressure and higher blood transfusion volume during surgery are independent risk factor of PGD.