Donor lung weight a novel predictor for primary graft dysfunction
Background: Primary graft dysfunction (PGD) remains a leading cause of early morbidity and mortality in lung transplantation. PGD is characterized by diffuse alveolar damage and the accumulation of extravascular lung water in the transplanted lung. Pre-existing injury and stress during the donation...
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Elsevier
2025-08-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425000667 |
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| author | Andreas Martinsson, MD Anders Thoren, MD, PhD Sven-Erik Ricksten, MD, PhD Jonatan Oras, MD, PhD Moustafa Mohsen Abed, MD Petra Vestlund, CTC Jesper M. Magnusson, MD, PhD Andreas Wallinder, MD, PhD |
| author_facet | Andreas Martinsson, MD Anders Thoren, MD, PhD Sven-Erik Ricksten, MD, PhD Jonatan Oras, MD, PhD Moustafa Mohsen Abed, MD Petra Vestlund, CTC Jesper M. Magnusson, MD, PhD Andreas Wallinder, MD, PhD |
| author_sort | Andreas Martinsson, MD |
| collection | DOAJ |
| description | Background: Primary graft dysfunction (PGD) remains a leading cause of early morbidity and mortality in lung transplantation. PGD is characterized by diffuse alveolar damage and the accumulation of extravascular lung water in the transplanted lung. Pre-existing injury and stress during the donation process are further aggravated by ischemia-reperfusion injury occurring during donation and transplantation. This study examines the relationship between adjusted donor lung weight, a surrogate for extravascular lung water, and outcomes following bilateral lung transplantation. Methods: We retrospectively analyzed 194 bilateral lung transplantations performed between January 2014 and May 2021. Donor lung weights were recorded after procurement, adjusted for body surface area, and categorized into quartiles. The primary outcomes assessed were the incidence of PGD (grades II and III) and duration of intensive care unit (ICU) stay. Secondary outcomes included mechanical ventilation duration, pulmonary function at discharge, and one-year mortality. Results: The incidence of PGD was significantly higher in the upper 4th quartile group (''high-weight,'' 22.9%) compared with the three lower quartile groups (''low-weight,'' 8.9%) (p = .020). Multivariate regression identified adjusted lung weight as an independent risk factor for PGD. The ''low-weight'' group showed higher rates of early extubation within 72 hours of lung transplantation (90.9% vs 83.0%, p = 0.048) and shorter ICU stays (median 3 vs 5 days, p = 0.026). No significant differences were found in ventilation duration, spirometry values, or 1-year survival. Conclusion: Adjusted donor lung weight is an independent predictor of PGD, suggesting that higher lung weights contribute to worse early outcomes post-transplant. Incorporating lung weight into donor assessment may improve recipient management and outcomes. |
| format | Article |
| id | doaj-art-c4f8045128604ac2a1e3be05eba14d03 |
| institution | DOAJ |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-c4f8045128604ac2a1e3be05eba14d032025-08-20T03:02:59ZengElsevierJHLT Open2950-13342025-08-01910027110.1016/j.jhlto.2025.100271Donor lung weight a novel predictor for primary graft dysfunctionAndreas Martinsson, MD0Anders Thoren, MD, PhD1Sven-Erik Ricksten, MD, PhD2Jonatan Oras, MD, PhD3Moustafa Mohsen Abed, MD4Petra Vestlund, CTC5Jesper M. Magnusson, MD, PhD6Andreas Wallinder, MD, PhD7Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Reprint requests: Andreas Martinsson, MD, Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, SwedenDepartment of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, SwedenDepartment of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, SwedenSahlgrenska University Hospital, Gothenburg, Sweden; Department of Pulmonary Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenUnit for Organ Coordination, Transplant Institute, Sahlgrenska University Hospital, Gothenburg, SwedenSahlgrenska University Hospital, Gothenburg, Sweden; Department of Pulmonary Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenDepartment of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Transplant Institute, Sahlgrenska University Hospital, Gothenburg, SwedenBackground: Primary graft dysfunction (PGD) remains a leading cause of early morbidity and mortality in lung transplantation. PGD is characterized by diffuse alveolar damage and the accumulation of extravascular lung water in the transplanted lung. Pre-existing injury and stress during the donation process are further aggravated by ischemia-reperfusion injury occurring during donation and transplantation. This study examines the relationship between adjusted donor lung weight, a surrogate for extravascular lung water, and outcomes following bilateral lung transplantation. Methods: We retrospectively analyzed 194 bilateral lung transplantations performed between January 2014 and May 2021. Donor lung weights were recorded after procurement, adjusted for body surface area, and categorized into quartiles. The primary outcomes assessed were the incidence of PGD (grades II and III) and duration of intensive care unit (ICU) stay. Secondary outcomes included mechanical ventilation duration, pulmonary function at discharge, and one-year mortality. Results: The incidence of PGD was significantly higher in the upper 4th quartile group (''high-weight,'' 22.9%) compared with the three lower quartile groups (''low-weight,'' 8.9%) (p = .020). Multivariate regression identified adjusted lung weight as an independent risk factor for PGD. The ''low-weight'' group showed higher rates of early extubation within 72 hours of lung transplantation (90.9% vs 83.0%, p = 0.048) and shorter ICU stays (median 3 vs 5 days, p = 0.026). No significant differences were found in ventilation duration, spirometry values, or 1-year survival. Conclusion: Adjusted donor lung weight is an independent predictor of PGD, suggesting that higher lung weights contribute to worse early outcomes post-transplant. Incorporating lung weight into donor assessment may improve recipient management and outcomes.http://www.sciencedirect.com/science/article/pii/S2950133425000667Donor lung weightPrimary graft dysfunctionICU stayBilateral lung transplantationTransplant complications |
| spellingShingle | Andreas Martinsson, MD Anders Thoren, MD, PhD Sven-Erik Ricksten, MD, PhD Jonatan Oras, MD, PhD Moustafa Mohsen Abed, MD Petra Vestlund, CTC Jesper M. Magnusson, MD, PhD Andreas Wallinder, MD, PhD Donor lung weight a novel predictor for primary graft dysfunction JHLT Open Donor lung weight Primary graft dysfunction ICU stay Bilateral lung transplantation Transplant complications |
| title | Donor lung weight a novel predictor for primary graft dysfunction |
| title_full | Donor lung weight a novel predictor for primary graft dysfunction |
| title_fullStr | Donor lung weight a novel predictor for primary graft dysfunction |
| title_full_unstemmed | Donor lung weight a novel predictor for primary graft dysfunction |
| title_short | Donor lung weight a novel predictor for primary graft dysfunction |
| title_sort | donor lung weight a novel predictor for primary graft dysfunction |
| topic | Donor lung weight Primary graft dysfunction ICU stay Bilateral lung transplantation Transplant complications |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425000667 |
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