Pan Jing, Zhang Jiejuan, Lu Xiali
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No.37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China.
Surg Today. 2025 Sep 17. doi: 10.1007/s00595-025-03129-4.
This meta-analysis evaluates the prevalence of primary graft dysfunction (PGD) and its risk factors after lung transplantation (LT). We searched databases (PubMed, EMBASE, Cochrane Library, Web of Science) up until May, 2024. STATA 16 was used for data analysis. Random or fixed effects models were used to summarize the prevalence of PGD and associated risk factors according to statistical tests for heterogeneity. Risk of bias was assessed with the Newcastle-Ottawa Scale. A total of 61 studies with 59,865 patients were included. The pooled prevalence of grade 2 and grade 3 PGD was 27% (95% CI 0.19, 0.34) and 18% (0.16, 0.21), respectively. Donor-related risk factors included older age (OR = 1.04; 95% CI 1.00, 1.58), female gender (OR = 1.67; 95% CI 1.13, 2.48), and smoking history (OR = 1.84; 1.47, 2.30). Recipient factors were female gender (OR = 1.51; 95% CI 1.32, 1.74), higher BMI (OR = 1.22; 95% CI 1.11, 1.33), idiopathic pulmonary fibrosis (OR = 2.08; 95% CI 1.64, 2.63), and pulmonary hypertension (OR = 2.19; 95% CI 1.50, 3.21). Operative risks included higher reperfusion FiO (OR = 1.13; 95% CI 1.01, 1.23), prolonged ischemic time (OR = 1.03; 95% CI 1.01, 1.05), and cardiopulmonary bypass use (OR = 2.38; 95% CI 1.79, 3.16). This study highlights the donor, recipient, and operative factors contributing to PGD risk, and emphasizes the need for targeted strategies in high-risk populations and further mechanistic research.
这项荟萃分析评估了肺移植（LT）后原发性移植功能障碍（PGD）的患病率及其危险因素。我们检索了截至2024年5月的数据库（PubMed、EMBASE、Cochrane图书馆、Web of Science）。使用STATA 16进行数据分析。根据异质性统计检验，采用随机或固定效应模型总结PGD的患病率及相关危险因素。采用纽卡斯尔-渥太华量表评估偏倚风险。共纳入61项研究，涉及59865例患者。2级和3级PGD的合并患病率分别为27%（95%CI 0.19，0.34）和18%（0.16，0.21）。与供体相关的危险因素包括年龄较大（OR = 1.04；95%CI 1.00，1.58）、女性（OR = 1.67；95%CI 1.13，2.48）和吸烟史（OR = 1.84；1.47，2.30）。受体因素包括女性（OR = 1.51；95%CI 1.32，1.74）、较高的体重指数（OR = 1.22；95%CI 1.11，1.33）、特发性肺纤维化（OR = 2.08；95%CI 1.64，2.63）和肺动脉高压（OR = 2.19；95%CI 1.50，3.21）。手术风险包括较高的再灌注FiO（OR = 1.13；95%CI 1.01，1.23）、较长的缺血时间（OR = 1.03；95%CI 1.01，1.05）和使用体外循环（OR = 2.38；95%CI 1.79，3.16）。本研究强调了导致PGD风险的供体、受体和手术因素，并强调了在高危人群中采取针对性策略和进一步进行机制研究的必要性。
