Re-evaluating the role of oxygen delivery and radiographs in the definition of primary graft dysfunction after lung transplantation: A Lung Transplant Outcomes Group cohort study.

IF 6.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation Pub Date : 2026-08-31 DOI:10.1016/j.healun.2026.08.016

Michaela R Anderson, Robert Gallop, A Russell Localio, Michelle Oyster, Laurel Kalman, Stephen Griffiths, Matthew Hartwig, Laurie D Snyder, Michael Shashaty, Vivek Ahya, Maria Crespo, Mauer Biscotti, Gabrielle Mezochow, Krishna Pandya, Julia Gasior, Daniel Calabrese, John R Greenland, Luke Benvenuto, Gundeep Dhillon, Michael P Combs, John McDyer, Chadi Hage, David Roe, Pali Shah, Christian Merlo, Jonathan P Singer, Scott M Palmer, Jason D Christie

{"title":"Re-evaluating the role of oxygen delivery and radiographs in the definition of primary graft dysfunction after lung transplantation: A Lung Transplant Outcomes Group cohort study.","authors":"Michaela R Anderson, Robert Gallop, A Russell Localio, Michelle Oyster, Laurel Kalman, Stephen Griffiths, Matthew Hartwig, Laurie D Snyder, Michael Shashaty, Vivek Ahya, Maria Crespo, Mauer Biscotti, Gabrielle Mezochow, Krishna Pandya, Julia Gasior, Daniel Calabrese, John R Greenland, Luke Benvenuto, Gundeep Dhillon, Michael P Combs, John McDyer, Chadi Hage, David Roe, Pali Shah, Christian Merlo, Jonathan P Singer, Scott M Palmer, Jason D Christie","doi":"10.1016/j.healun.2026.08.016","DOIUrl":null,"url":null,"abstract":"Background: Primary graft dysfunction (PGD) is severe lung injury following lung transplantation. Variable radiograph interpretation and changes in mechanical ventilation and extracorporeal membrane oxygenation (ECMO) support for hypoxemia may limit the current PGD definition's validity.Methods: We assessed whether changes in the PGD definition accounting for oxygen delivery method (intubated, non-intubated, ECMO) were associated with differential graft survival. Severe PGD was grade 3 at 48 or 72 hours after transplant. We estimated crude and standardized time from transplantation to death or retransplantation with each alternate defining criterion. We secondarily evaluated whether excluding chest radiography led to severe PGD re-classification.Results: Among 3,170 recipients, 749 (24%) had severe PGD by current definition. By revised oxygen delivery definition, 182 non-intubated recipients and 372 intubated recipients had severe PGD, and 177 recipients had severe PGD requiring ECMO. Recipients with severe PGD requiring ECMO had the highest 1-year mortality (cumulative incidence of death 0.20, 95%CI 0.17-0.24), followed by intubated severe PGD (0.15, 95%CI 0.13-0.17). Non-intubated recipients had similar mortality with and without severe PGD (non-intubated with PGD: 1-year cumulative incidence of death 0.11, 95%CI 0.09-0.13; non-intubated without severe PGD: 0.10, 95%CI 0.09-0.11). Exclusion of radiographs reclassified 814 recipients, including 89 (11%) reclassified as severe PGD. On review of radiographs from recipients reclassified as severe PGD, the most frequent findings were effusions, atelectasis, and pneumonia.Conclusion: A revised PGD definition stratified by mode of oxygen delivery identifies groups with differential mortality. Chest radiography is critical to excluding alternative causes of lung injury in recipients with severe hypoxemia.","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.7000,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Heart and Lung Transplantation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.healun.2026.08.016","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Primary graft dysfunction (PGD) is severe lung injury following lung transplantation. Variable radiograph interpretation and changes in mechanical ventilation and extracorporeal membrane oxygenation (ECMO) support for hypoxemia may limit the current PGD definition's validity.

Methods: We assessed whether changes in the PGD definition accounting for oxygen delivery method (intubated, non-intubated, ECMO) were associated with differential graft survival. Severe PGD was grade 3 at 48 or 72 hours after transplant. We estimated crude and standardized time from transplantation to death or retransplantation with each alternate defining criterion. We secondarily evaluated whether excluding chest radiography led to severe PGD re-classification.

Results: Among 3,170 recipients, 749 (24%) had severe PGD by current definition. By revised oxygen delivery definition, 182 non-intubated recipients and 372 intubated recipients had severe PGD, and 177 recipients had severe PGD requiring ECMO. Recipients with severe PGD requiring ECMO had the highest 1-year mortality (cumulative incidence of death 0.20, 95%CI 0.17-0.24), followed by intubated severe PGD (0.15, 95%CI 0.13-0.17). Non-intubated recipients had similar mortality with and without severe PGD (non-intubated with PGD: 1-year cumulative incidence of death 0.11, 95%CI 0.09-0.13; non-intubated without severe PGD: 0.10, 95%CI 0.09-0.11). Exclusion of radiographs reclassified 814 recipients, including 89 (11%) reclassified as severe PGD. On review of radiographs from recipients reclassified as severe PGD, the most frequent findings were effusions, atelectasis, and pneumonia.

Conclusion: A revised PGD definition stratified by mode of oxygen delivery identifies groups with differential mortality. Chest radiography is critical to excluding alternative causes of lung injury in recipients with severe hypoxemia.

查看原文本刊更多论文

重新评估氧输送和x线片在肺移植后原发性移植物功能障碍定义中的作用：一项肺移植结局组队列研究。

背景：原发性移植物功能障碍（PGD）是肺移植术后严重的肺损伤。不同的x线片解释和机械通气和体外膜氧合（ECMO）支持低氧血症的变化可能限制当前PGD定义的有效性。方法：我们评估了考虑输氧方法（插管、非插管、ECMO）的PGD定义的变化是否与移植物存活率的差异有关。移植后48或72小时重度PGD为3级。我们估计了从移植到死亡或再移植的粗糙和标准化时间。我们再次评估排除胸片检查是否会导致严重的PGD重新分类。结果：在3170名接受者中，749名（24%）有目前定义的严重PGD。根据修订的供氧定义，182名非插管受者和372名插管受者有严重PGD， 177名受者有严重PGD需要ECMO。需要ECMO的严重PGD患者的1年死亡率最高（累计死亡发生率0.20,95%CI 0.17-0.24），其次是插管的严重PGD患者（0.15,95%CI 0.13-0.17）。非插管受者在有和没有严重PGD的情况下死亡率相似（未插管有PGD: 1年累积死亡率0.11,95%CI 0.09-0.13；未插管没有严重PGD: 0.10, 95%CI 0.09-0.11）。排除x线片重新分类814例受检者，其中89例（11%）重新分类为重度PGD。重新分类为严重PGD的受者的x线片显示，最常见的表现是积液、肺不张和肺炎。结论：经修订的PGD定义以供氧方式分层，确定了不同死亡率的组。胸部x线摄影对于排除严重低氧血症患者肺损伤的其他原因至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Heart and Lung Transplantation 医学-呼吸系统

CiteScore

10.10

自引率

6.70%

发文量

1667

审稿时长

69 days

期刊介绍： The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.