Donor and recipient factors associated with primary graft dysfunction following lung transplantation: A donor management goal registry analysis

Background: Current risk-adjusted models for predicting primary graft dysfunction (PGD) following lung transplantation (LTx) do not include bedside donor critical care data. Donor management goals (DMGs) represent predefined critical care endpoints aimed at optimizing multiorgan donor management. Here we sought to identify novel predictors to better understand the relationship between donor management and PGD following LTx.

Methods: We used the national DMG registry to identify a cohort of LTx recipients linked to their respective donors between January 1, 2015, and March 1, 2023. Grade 3 PGD (PGD3) was defined according to modified International Society for Heart and Lung Transplantation criteria. Multivariable modeling was performed to identify risk factors for the development of PGD3.

Results: A total of 2704 eligible patients were identified, of whom 643 (23.8%) developed PGD3. After multivariable modeling, the likelihood of PGD3 was greater with increasing donor age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.10 per 5-year change; P = .003), increasing donor serum pH at the time of authorization (OR, 1.14; 95% CI, 1.02-1.25 per 0.1-point increase; P = .016), donor history of cocaine use (OR, 1.34; 95% CI, 1.05-1.71; P = .020), and increased recipient central venous pressure (OR, 1.03; 95% CI, 1.01-1.06; P = .005). Recipients who received donor lungs in which the DMG for PF ratio was met had a lower likelihood of developing PGD3 (OR, 0.63; 95% CI, 0.46-0.86; P = .006).

Conclusions: This study leverages a novel detailed donor management database to identify factors associated with the development of PGD3. These factors may be used to recognize donors and recipients who may benefit from early interventions to improve short-term outcomes.