PRIMARY GRAFT FAILURE FOLLOWING LUNG TRANSPLANTATION

Study objectives: To determine the incidence of primary graft failure (PGF) following lung transplantation, assess possible risk factors, an d characterize its effect on outcomes. Methods: Retrospective review o f 100 consecutive patients undergoing lung transplantation at the Univ ersity of Pennsylvania Medical Center. Fifteen patients meeting diagno stic criteria for PGF (PGF+ group) were compared with 85 patients with out this complication (PGF- group). Results: The incidence of PGF was 15%, There was no significant difference in age, sex, underlying pulmo nary disease, preoperative pulmonary artery systolic pressure, type of transplant, allograft ischemic times, use of cardiopulmonary bypass, or use of postoperative prostaglandin E-1 infusion between the PGF+ an d PGF- groups.Induction therapy with antilymphocyte globulin was used less frequently in the PGF+ group (p<0.005), Duration of mechanical ve ntilatory support was 36+/-43 days vs 4+/-6 days for the PGF+ and PGF- groups, respectively (p<0.0001). Hospital stay was significantly long er in the PGF+ group, averaging 75+/-105 days, compared with 27+/-38 d ays in the PGF group (p < 0.005). One-year actuarial survival for the PGF+ group was only 40% compared with 69% for the PGF- group (p<0,005) . Five of the six: PGF+ survivors were ambulatory by 1. year; three we re completely independent while two continued to require assistance wi th activities of daily living. Six-minute walk test distance among the ambulatory patients averaged 883+/-463 feet (range, 200 to 1,223 feet ) compared with 1513+/-424 feet for the PGF- group (p<0,005), Among th e subset of survivors who underwent single lung transplantation for CO PD, the mean percent predicted FEV1 at 1 year was 43% for the PGF+ gro up and 55% for the PGF- groups, but this difference was not statistica lly significant. Conclusions: PGF is a devastating postoperative compl ication, occuring in 15% of patients in the current series, and it is associated with a high mortality rate, lengthy hospitalization, and pr otracted and often compromised recovery among survivors.