Severe Graft Dysfunction More Frequent After Prioritized Lung Transplantation, but Association Attenuates After Adjustment

Primary graft dysfunction (PGD) is a leading cause of early morbidity and mortality after lung transplantation. Researchers retrospectively analyzed a prospectively maintained cohort of 310 consecutive lung transplant recipients at a tertiary center between January 2016 and June 2025. They compared recipients by waiting-list prioritization status, defining severe PGD as grade 3 under International Society for Heart and Lung Transplantation criteria.

Of the recipients, 74 (23.8%) were prioritized. These patients were younger, more frequently had pulmonary hypertension, and were more likely to be hospitalized before transplantation, particularly in intensive care. Severe PGD occurred in 24% of prioritized recipients versus 7% of non-prioritized recipients. However, prioritization was not independently associated with severe PGD after adjustment. Pretransplant extracorporeal membrane oxygenation support was the strongest independent predictor. Thirty-day mortality was similar between groups, while prioritized recipients had higher 90-day and 1-year mortality.

The findings suggest that underlying clinical severity and advanced support requirements, rather than prioritization itself, may explain the higher crude PGD rate. The single-center observational design limits causal interpretation and generalizability. Only the abstract was available; adjusted effect estimates, confidence intervals, adjustment variables, and absolute mortality rates were not reported in it.