Primary graft dysfunction grade 3 following pediatric lung transplantation is associated with chronic lung allograft dysfunction

Wai Wong, Brandy Johnson, Pi Chun Cheng, Maureen B. Josephson, Katsuhide Maeda, Robert A. Berg, Steven M. Kawut, Michael O. Harhay, Samuel B. Goldfarb, Nadir Yehya, Adam S. Himebauch

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2 Scopus citations

Abstract

Background: Severe primary graft dysfunction (PGD) is associated with the development of bronchiolitis obliterans syndrome (BOS), the most common form of chronic lung allograft dysfunction (CLAD), in adults. However, PGD associations with long-term outcomes following pediatric lung transplantation are unknown. We hypothesized that PGD grade 3 (PGD 3) at 48- or 72-hours would be associated with shorter CLAD-free survival following pediatric lung transplantation. Methods: This was a single center retrospective cohort study of patients ≤ 21 years of age who underwent bilateral lung transplantation between 2005 and 2019 with ≥ 1 year of follow-up. PGD and CLAD were defined by published criteria. We evaluated the association of PGD 3 at 48- or 72-hours with CLAD-free survival by using time-to-event analyses. Results: Fifty-one patients were included (median age 12.7 years; 51% female). The most common transplant indications were cystic fibrosis (29%) and pulmonary hypertension (20%). Seventeen patients (33%) had PGD 3 at either 48- or 72-hours. In unadjusted analysis, PGD 3 was associated with an increased risk of CLAD or mortality (HR 2.10, 95% CI 1.01-4.37, p=0.047). This association remained when adjusting individually for multiple potential confounders. There was evidence of effect modification by sex (interaction p = 0.055) with the association of PGD 3 and shorter CLAD-free survival driven predominantly by males (HR 4.73, 95% CI 1.44-15.6) rather than females (HR 1.23, 95% CI 0.47-3.20). Conclusions: PGD 3 at 48- or 72-hours following pediatric lung transplantation was associated with shorter CLAD-free survival. Sex may be a modifier of this association.

Original languageEnglish (US)
Pages (from-to)669-678
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume42
Issue number5
DOIs
StatePublished - May 2023

Bibliographical note

Funding Information:
Wai Wong, Brandy Johnson, Pi Chun Cheng, Maureen B. Josephson, Katsuhide Maeda, and Samuel B. Goldfarb have no disclosures. Grant funding was paid to the affiliated institutions in support of ongoing work of Robert A. Berg (NIH 5R01-HL147616-03, NIH 1RL1HD107777-01), Steven M. Kawut (NIH K24-HL103844), Michael O. Harhay, PhD (NIH R00-HL141678, PCORI Grant ME-2020C1-19220), Nadir Yehya (NIH 5R01HL148054-03), and Adam S. Himebauch (NIH 5K23-HL15375).

Publisher Copyright:
© 2022 International Society for Heart and Lung Transplantation

Keywords

  • bronchiolitis obliterans syndrome
  • chronic lung allograft dysfunction
  • pediatric
  • primary graft dysfunction
  • rejection
  • transplant

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

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