Abstract Background Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation (LTx). Baseline lung allograft dysfunction (BLAD), indicating impaired graft function one year after LTx, is less well characterized, and its relationship with PGD remains uncertain. Aims We aimed to identify risk factors for PGD and assess its association with BLAD and outcomes. Methods All LTx recipients at Lausanne University Hospital (2008–2021) were retrospectively analyzed. Multivariate logistic regression identified risk factors for PGD and its association with BLAD and survival. Results Among 276 patients, 65 (23.6 %) developed PGD III. Independent predictors were younger age (OR 0.98/y, p = 0.025), female sex (OR 2.45, p = 0.003), lower donor PaO₂/FiO₂ (OR 0.99 per 10 mmHg, p = 0.02), and higher transfusions (OR 3.3, p 0.01). PGD III was associated with prolonged ventilation (57 % vs 15 %, p 0.01), reoperation (32 % vs 13 %, p 0.01), longer ICU (22 vs 5 days, p 0.001), and hospital stay (38 vs 24 days, p 0.001). BLAD occurred more often in PGD III (59 % vs 38 %, OR 2.4, p = 0.009) and in patients transplanted for fibrotic lung disease (36 % vs 9 %, OR 5.8, p 0.001). BLAD correlated with higher transfusions, reoperation, and prolonged ventilation. Survival did not differ between PGD III and non-PGD (1-, 3-, 5-y: 83.5 %, 74.2 %, 66.0 % vs 95.7 %, 87.1 %, 79.0 %; p = 0.53) nor between BLAD and non-BLAD. Conclusion PGD III after LTx is associated with increased perioperative morbidity and a higher risk of BLAD. Both conditions correlate with transfusion requirements and ventilatory complications, emphasizing the need for targeted perioperative strategies to improve graft recovery and long-term function.
Hasenauer et al. (Mon,) studied this question.