Martinsson Andreas, Thoren Anders, Ricksten Sven-Erik, Oras Jonatan, Abed Moustafa Mohsen, Vestlund Petra, Magnusson Jesper M, Wallinder Andreas
Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Sahlgrenska University Hospital, Gothenburg, Sweden.
JHLT Open. 2025 Apr 30;9:100271. doi: 10.1016/j.jhlto.2025.100271. eCollection 2025 Aug.
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.
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.
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%) ( = .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%, = 0.048) and shorter ICU stays (median 3 vs 5 days, = 0.026). No significant differences were found in ventilation duration, spirometry values, or 1-year survival.
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.
原发性移植肺功能障碍（PGD）仍然是肺移植早期发病和死亡的主要原因。PGD的特征是弥漫性肺泡损伤和移植肺血管外肺水积聚。捐赠过程中预先存在的损伤和应激会因捐赠和移植过程中发生的缺血再灌注损伤而进一步加重。本研究探讨了作为血管外肺水替代指标的调整后供肺重量与双侧肺移植术后结局之间的关系。
我们回顾性分析了2014年1月至2021年5月期间进行的194例双侧肺移植病例。获取供肺后记录其重量，并根据体表面积进行调整，然后分为四分位数。评估的主要结局是PGD（II级和III级）的发生率和重症监护病房（ICU）住院时间。次要结局包括机械通气时间、出院时的肺功能和一年死亡率。
与三个较低四分位数组（“低重量”组，8.9%）相比，上四分位数组（“高重量”组，22.9%）的PGD发生率显著更高（P = 0.020）。多因素回归分析确定调整后的肺重量是PGD的独立危险因素。“低重量”组在肺移植后72小时内的早期拔管率更高（90.9%对83.0%，P = 0.048），ICU住院时间更短（中位数3天对5天，P = 0.026）。在通气时间、肺量计值或1年生存率方面未发现显著差异。
调整后的供肺重量是PGD的独立预测指标，表明较高的肺重量会导致移植后早期结局更差。将肺重量纳入供体评估可能会改善受体管理和结局。
