Postoperative estradiol levels associate with development of primary graft dysfunction in lung transplantation patients

Lung transplantation and gender effects on survival of recipients with cystic fibrosis

BACKGROUND

The overall life expectancy of women with cystic fibrosis (CF) is shorter compared with men with CF without accounting for lung transplant recipients. However, it is unclear how donor and recipient gender impact long-term outcomes in patients with CF who undergo lung transplantation. The purpose of this study was to determine if the gender disadvantage seen in women with CF before transplant continues to exist after lung transplant and if this is impacted by donor gender.

METHODS

Patients with CF entered in the International Society for Heart and Lung Transplantation registry who were at least 18 years old and received a lung transplant between January 2000 and December 2012 were included and divided into groups based on donor-recipient gender combinations. Kaplan-Meier curves were used to determine post-transplant rates of overall survival and bronchiolitis obliterans syndrome (BOS)-free survival.

RESULTS

The analysis included 4,971 patients undergoing lung transplantation for CF. There was no significant difference in BOS-free survival or overall survival rates between genders or between gender-matched vs gender-mismatched recipients after lung transplantation. However, women with CF underwent transplantation at a younger age and died at an earlier overall age than men with CF.

CONCLUSIONS

Survival after lung transplantation and time to the development of BOS did not differ based on gender or donor-recipient gender combination. However, women with CF continue to demonstrate a poorer overall life expectancy, as their pre-transplant disadvantage could not be overcome after lung transplantation.

Primary graft dysfunction

Primary graft dysfunction (PGD) is a syndrome encompassing a spectrum of mild to severe lung injury that occurs within the first 72 hours after lung transplantation. PGD is characterized by pulmonary edema with diffuse alveolar damage that manifests clinically as progressive hypoxemia with radiographic pulmonary infiltrates. In recent years, new knowledge has been generated on risks and mechanisms of PGD. Following ischemia and reperfusion, inflammatory and immunological injury-repair responses appear to be key controlling mechanisms. In addition, PGD has a significant impact on short- and long-term outcomes; therefore, the choice of donor organ is impacted by this potential adverse consequence. Improved methods of reducing PGD risk and efforts to safely expand the pool are being developed. Ex vivo lung perfusion is a strategy that may improve risk assessment and become a promising platform to implement treatment interventions to prevent PGD. This review details recent updates in the epidemiology, pathophysiology, molecular and genetic biomarkers, and state-of-the-art technical developments affecting PGD.