Impact of anastomosis time during lung transplantation on primary graft dysfunction

Vandervelde, Christelle M; Vos, Robin; Vanluyten, Cedric; Fieuws, Steffen; Verleden, Stijn E; Van Slambrouck, Jan; De Leyn, Paul; Coosemans, Willy; Nafteux, Philippe; Decaluwe, Herbert; Van Veer, Hans; Depypere, Lieven; Dauwe, Dieter F; De Troy, Erwin; Ingels, Catherine M; Neyrinck, Arne P; Jochmans, Ina; Vanaudenaerde, Bart M; Godinas, Laurent; Verleden, Geert M; Van Raemdonck, Dirk E; Ceulemans, Laurens J

doi:10.1111/ajt.16957

Impact of anastomosis time during lung transplantation on primary graft dysfunction

Author:

Vandervelde, Christelle M

Vos, Robin ; Vanluyten, Cedric ; Fieuws, Steffen ; Verleden, Stijn E ; Van Slambrouck, Jan ; De Leyn, Paul ; Coosemans, Willy ; Nafteux, Philippe ; Decaluwe, Herbert ; Van Veer, Hans ; Depypere, Lieven ; Dauwe, Dieter F ; De Troy, Erwin ; Ingels, Catherine M ; Neyrinck, Arne P ; Jochmans, Ina ; Vanaudenaerde, Bart M ; Godinas, Laurent ; Verleden, Geert M ; Van Raemdonck, Dirk E ; Ceulemans, Laurens J

Keywords:

Science & Technology, Life Sciences & Biomedicine, Surgery, Transplantation, anastomosis time, implantation, ischemic time, lung transplantation, primary graft dysfunction, surgical technique, CONSENSUS GROUP STATEMENT, CLINICAL RISK-FACTORS, ISHLT WORKING GROUP, LONG-TERM OUTCOMES, INTERNATIONAL SOCIETY, REPERFUSION INJURY, ISCHEMIA, HEART, TRANSFUSION, ASSOCIATION, Anastomosis, Surgical, Cohort Studies, Humans, Lung Transplantation, Primary Graft Dysfunction, Retrospective Studies, Risk Factors, 1803521N#56522477, 11 Medical and Health Sciences, 3202 Clinical sciences, 3204 Immunology

Abstract:

Primary graft dysfunction (PGD) is a major obstacle after lung transplantation (LTx), associated with increased early morbidity and mortality. Studies in liver and kidney transplantation revealed prolonged anastomosis time (AT) as an independent risk factor for impaired short- and long-term outcomes. We investigated if AT during LTx is a risk factor for PGD. In this retrospective single-center cohort study, we included all first double lung transplantations between 2008 and 2016. The association of AT with any PGD grade 3 (PGD3) within the first 72 h post-transplant was analyzed by univariable and multivariable logistic regression analysis. Data on AT and PGD was available for 427 patients of which 130 (30.2%) developed PGD3. AT was independently associated with the development of any PGD3 ≤72 h in uni- (odds ratio [OR] per 10 min 1.293, 95% confidence interval [CI 1.136-1.471], p < .0001) and multivariable (OR 1.205, 95% CI [1.022-1.421], p = .03) logistic regression analysis. There was no evidence that the relation between AT and PGD3 differed between lung recipients from donation after brain death versus donation after circulatory death donors. This study identified AT as an independent risk factor for the development of PGD3 post-LTx. We suggest that the implantation time should be kept short and the lung cooled to decrease PGD-related morbidity and mortality post-LTx.