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Clinical Investigations: TRANSPLANTATION |

Primary Graft Failure Following Lung Transplantation*: Predictive Factors of Mortality

Gabriel Thabut, MD; Isabelle Vinatier, MD; Jean-Baptiste Stern, MD; Guy Lesèche, MD; Philippe Loirat, MD; Michel Fournier, MD; Hervé Mal, MD
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*From the Service de Pneumologie et Réanimation Respiratoire (Drs. Thabut and Stern), and Service de Chirurgie Thoracique et vasculaire (Dr. Lesèche), Beaujon, Clichy; the Groupe de Transplantation Pulmonaire (Drs. Vinatier and Loirat), Hôpital Foch, Suresnes; and Unité Inserm 408 (Drs. Fournier and Mal), Faculté de Médecine Xavier Bichat, Paris, France.

Correspondence to: Gabriel Thabut, MD, Service de Pneumologie et Réanimation, Hôpital Beaujon, 100 avenue du Général Leclerc, 92110 Clichy, France; e-mail: gabriel.thabut@bjn.ap-hop-paris.fr



Chest. 2002;121(6):1876-1882. doi:10.1378/chest.121.6.1876
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Study objectives: To assess incidence, outcome, and early predictors of mortality for patients with primary graft failure (PGF) following lung transplantation (LTx), and to develop an injury severity score able to accurately predict ICU mortality for these patients.

Design: Retrospective cohort analysis.

Setting: Two LTx centers in Paris.

Patients: Two hundred fifty-nine patients who underwent LTx over a 12-year period.

Measurements and results: One hundred thirty-one patients (50.6%) met PGF criteria: radiographic graft infiltrate within the first 3 days following LTx associated with gas exchange impairment (Pao2/fraction of inspired oxygen ratio < 300 mm Hg). This syndrome was associated with an increased duration of mechanical ventilation (9.1 ± 1 days vs 3.1 ± 0.6 days, mean ± SD; p < 0.001) and ICU mortality (29% vs 10.9%; p < 0.01). The patients with PGF were randomly assigned to developmental (n = 85) and validation (n = 46) samples. Using logistic regression analysis, four variables were found associated with ICU mortality in these patients: age, degree of gas exchange impairment, graft ischemic time, and severe early hemodynamic failure. An ischemia/reperfusion injury severity score was derived using these four variables. Model calibration was good in the developmental and validation samples, as was model discrimination (area under receiver operating characteristic curves, 0.93 and 0.85, respectively).

Conclusion: PGF following LTx is a frequent event, with significant ICU morbidity and mortality. We demonstrate that four simple factors allow prediction of ICU mortality with good accuracy.

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