Lung Allograft Function After Primary Graft Dysfunction in the Lung Transplant Outcomes Group Cohort
Krishna Pandya, Robert Gallop, A Russell Localio, Jesse Y Hsu, Michelle Oyster, Laurel Kalman, Jamie L Todd, Megan L Neely, Joshua M Diamond, Michael Shashaty, Andrew M Courtwright, Vivek Ahya, Maria Crespo, Edward Cantu, Christian Bermudez, Mauer Biscotti, Emily Clausen, Gabrielle Mezochow, Douglas Schaubel, Daniel Calabrese, John R Greenland, Luke Benvenuto, Gundeep Dhillon, Michael P Combs, John McDyer, Mrunal Patel, Pali Shah, Christian Merlo, Matthew Hartwig, Laurie D Snyder, Jonathan P Singer, Scott M Palmer, Jason D Christie, Michaela R AndersonAbstract
Rationale
Primary graft dysfunction (PGD) after lung transplant is associated with increased mortality. Whether PGD increases mortality via long-term effects on allograft function is poorly understood.
Objective
Evaluate the association of PGD with potential lung function and chronic lung allograft dysfunction (CLAD).
Methods
We included lung transplant recipients enrolled in an 8-center prospective cohort study from 2007-2018. PGD was defined by ISHLT criteria. Linear mixed effects and logistic regression models evaluated the association between PGD and maximum potential forced expiratory volume in 1 second (FEV1) and whether Global Lung Function Initiative defined (GLI) predicted FEV1 was attained, respectively. Flexible parametric survival models evaluated the association between PGD and CLAD, accounting for confounding and mortality as a competing risk.
Measurements and Main Results
Among 2419 recipients, 510 had PGD. Recipients with PGD had lower maximum potential FEV1 (-311 ml, 95% CI -245 to -377 ml) and were less likely to achieve GLI-predicted FEV1 (probability difference -12.5%, 95% CI -17 to -8%). 930 recipients developed CLAD (405 obstructive, 525 restrictive) over median (IQR) 5.9 (3.0-8.0 years). The 5-year cumulative incidence of CLAD did not differ by PGD (cumulative difference: -2.2%, 95% CI - 6.4% to 1.9%). This association was not modified by age, sex, BMI, pretransplant diagnosis, or transplant type. PGD was not associated with a difference in cumulative incidence of obstructive or restrictive CLAD (cumulative difference -1.2% and -0.8%, respectively).
Conclusion
PGD is associated with reduced lung function and lower likelihood of achieving GLI-predicted maximum potential lung function but not CLAD.