Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation

Abstract

Since candidates with comorbidities are increasingly referred for lung transplantation, knowledge about comorbidities and their cumulative effect on outcomes is scarce. We retrospectively collected pretransplant comorbidities of all 513 adult recipients transplanted at our center between 1992-2019. Multiple logistic- and Cox regression models, adjusted for donor-, pre- and peri-operative variables, were used to detect independent risk factors for primary graft dysfunction grade-3 at 72 h (PGD3-T72), onset of chronic allograft dysfunction grade-3 (CLAD-3) and survival. An increasing comorbidity burden measured by Charleston-Deyo-Index was a multivariable risk for survival and PGD3-T72, but not for CLAD-3. Among comorbidities, congestive right heart failure or a mean pulmonary artery pressure >25 mmHg were independent risk factors for PGD3-T72 and survival, and a borderline risk for CLAD-3. Left heart failure, chronic atrial fibrillation, arterial hypertension, moderate liver disease, peptic ulcer disease, gastroesophageal reflux, diabetes with end organ damage, moderate to severe renal disease, osteoporosis, and diverticulosis were also independent risk factors for survival. For PGD3-T72, a BMI>30 kg/m2 was an additional independent risk. Epilepsy and a smoking history of the recipient of >20packyears are additional independent risk factors for CLAD-3. The comorbidity profile should therefore be closely considered for further clinical decision making in candidate selection.

Keywords: Charlson-Deyo-Index; chronic allograft dysfunction; comorbidities; lung transplantation; primary graft dysfunction; recipient selection.

FIGURE 1

Distribution of the recipient comorbidity burden over the study period, measured by the Charlson-Deyo-Index. The first scoring point accounts for the always present underlying lung disease.

FIGURE 2

(A) Kaplan-Meier survival curves for different comorbidity burdens in the Charlson-Deyo-Index. 1 vs. 2 log-rank = 0.004, 2 vs. 3 log-rank = 0.776, 3 vs. 4 log rank = 0.020, 4 vs. ≥5 log rank = 0.045. (B) Kaplan-Meier curve for onset of CLAD-3 for different comorbidity burdens in the Charlson-Deyo-Index. 1 vs. 2 log-rank = 0.001, 2 vs. 3 log-rank = 0.927, 3 vs. 4 log rank = 0.537, 4 vs. ≥5 log rank = 0.059.