Analysis of risk factors and prognostic evaluation of early primary graft dysfunction after lung transplantation

Objective To explore the risk factors for early primary graft dysfunction (PGD) after lung transplantation, analyze the dose-effect relationship between cold ischemia time and PGD severity, and evaluate the impact of PGD on patient's short-term and long-term prognosis.

Methods A retrospective analysis was conducted on the clinical data of 156 patients who underwent lung transplantation in the hospital from January 2020 to December 2024. Based on the occurrence of PGD within 72 h after surgery, patients were divided into PGD group (n=42) and non-PGD group (n=114). Data on donor characteristics, recipient baseline information, surgery-related indicators, and postoperative complications were collected. Univariate analysis and multivariate Logistic regression models were used to screen independent risk factors for PGD occurrence. Survival curves were plotted using the Kaplan-Meier method, and the Log-rank test was employed to compare the survival rates between the two groups. Additionally, the Cox proportional hazards regression model was used to analyze the impact of PGD on patient's prognosis.

Results Among the 156 patients, the incidence rate of PGD was 26.9% (42/156). Univariate analysis revealed that donor age >55 years, donor smoking history ≥20 packs per year, donor oxygenation index < 300 mmHg, recipient preoperative history of chronic obstructive pulmonary disease (COPD), recipient preoperative creatinine >110 μmol/L, cold ischemia time >6 h, surgery time >4 h, and the use of cardiopulmonary bypass (CPB) were potential risk factors for PGD occurrence (P < 0.05). Multivariate Logistic regression analysis showed that donor age >55 years (OR=3.215, 95%CI, 1.423 to 7.241, P=0.005), cold ischemia time >6 h (OR=2.897, 95%CI, 1.268 to 6.614, P=0.012), recipient preoperative creatinine >110 μmol/L (OR=2.534, 95%CI, 1.098 to 5.827, P=0.030), and CPB use (OR=3.012, 95%CI, 1.305 to 6.928, P=0.010) were independent risk factors for PGD occurrence. Survival analysis indicated that the 30-day, 1-year, and 3-year survival rates of patients in the PGD group were 71.4%, 52.4% and 38.1% respectively, which were significantly lower than 92.1%, 83.3% and 75.4% respectively in the non-PGD group (Log-rank χ²=28.643, P < 0.001). Cox regression analysis demonstrated that PGD was an independent risk factor for postoperative death in patients (HR=3.125, 95%CI, 1.876 to 5.198, P < 0.001).

Conclusion Donor age >55 years, cold ischemia time >6 h, recipient preoperative renal insufficiency (creatinine >110 μmol/L), and CPB use are independent risk factors for early PGD after lung transplantation. PGD significantly reduces patient's short-term and long-term survival rates. Clinically, it is necessary to optimize donor selection, shorten cold ischemia time, improve recipient preoperative renal function, and use CPB cautiously to reduce the incidence rate of PGD and improve patient's prognosis.