Incidence of primary graft dysfunction and its associated risk factors after lung transplantation: a systematic review and meta-analysis.

This meta-analysis evaluates the prevalence of primary graft dysfunction (PGD) and its risk factors after lung transplantation (LT). We searched databases (PubMed, EMBASE, Cochrane Library, Web of Science) up until May, 2024. STATA 16 was used for data analysis. Random or fixed effects models were used to summarize the prevalence of PGD and associated risk factors according to statistical tests for heterogeneity. Risk of bias was assessed with the Newcastle-Ottawa Scale. A total of 61 studies with 59,865 patients were included. The pooled prevalence of grade 2 and grade 3 PGD was 27% (95% CI 0.19, 0.34) and 18% (0.16, 0.21), respectively. Donor-related risk factors included older age (OR = 1.04; 95% CI 1.00, 1.58), female gender (OR = 1.67; 95% CI 1.13, 2.48), and smoking history (OR = 1.84; 1.47, 2.30). Recipient factors were female gender (OR = 1.51; 95% CI 1.32, 1.74), higher BMI (OR = 1.22; 95% CI 1.11, 1.33), idiopathic pulmonary fibrosis (OR = 2.08; 95% CI 1.64, 2.63), and pulmonary hypertension (OR = 2.19; 95% CI 1.50, 3.21). Operative risks included higher reperfusion FiO₂ (OR = 1.13; 95% CI 1.01, 1.23), prolonged ischemic time (OR = 1.03; 95% CI 1.01, 1.05), and cardiopulmonary bypass use (OR = 2.38; 95% CI 1.79, 3.16). This study highlights the donor, recipient, and operative factors contributing to PGD risk, and emphasizes the need for targeted strategies in high-risk populations and further mechanistic research.