Cardiovascular

Lower lung donor PaO2/FiO2 ratio correlates with early primary graft dysfunction, but does not impact overall survival after lung transplantation: a dual center study.

Novysedlak R, Vanluyten C, et al. • Transplant international : official journal of the European Society for Organ Transplantation • 2026

PubMed 42920666 DOI 10.3389/ti.2026.16414
TL;DR

Lower donor PFR is associated with increased risk of early (24 h) PGD grade 3, but not with PGD grade 3 at 72 h, acute cellular rejection, or 2-year overall survival after lung transplantation.

Key Findings

Results

Lower donor PaO2/FiO2 ratio (PFR) was identified as a risk factor for primary graft dysfunction (PGD) grade 3 at 24 hours after lung transplantation.

  • Logistic regression analyses identified lower donor PFR as a risk factor for PGD grade 3 at 24 h.
  • The study included 984 lung transplant recipients from two centers (Leuven and Prague).
  • Donor PFR was measured from an arterial blood gas sample.
Results

Donor PFR was not a risk factor for PGD grade 3 at 72 hours.

  • The association seen at 24 h was not present at 72 h.
  • The authors conclude that donor PFR does not appear to be a risk factor for late PGD.
Results

Donor PFR was not associated with 2-year overall survival after lung transplantation.

  • Survival was analyzed with Kaplan-Meier estimates and Cox regression.
  • Median follow-up was 4 years.
  • Two-year overall survival was a primary endpoint.
Results

Donor PFR was not associated with the incidence of acute cellular rejection (ACR).

  • ACR incidence was a secondary endpoint.
  • CLAD-free survival was also a secondary endpoint; the abstract reports no adverse impact of donor PFR on outcomes.
Methods

The study was a large two-center retrospective cohort of adult lung transplant recipients with defined characteristics.

  • 984 recipients: Leuven 2010–2022 and Prague 2018–March 2023.
  • Recipients were predominantly male (54%); COPD was the most common transplant indication.
  • Median donor age was 51 years and 18% of donors were donation after circulatory death (DCD).
  • Median follow-up was 4 years.
Conclusions

The authors conclude that the arbitrary donor PFR threshold of 300 may lead to unnecessary decline of extended criteria donor lungs, since low PFR affects early PGD but not later outcomes.

  • Extended criteria donor lungs below PFR 300 are frequently declined despite other acceptable parameters.
  • Donor PFR is associated with increased risk of early PGD but does not appear to adversely impact survival or late PGD.

What This Means

This study looked at whether the oxygenation level of a donor's lungs, measured by the PaO2/FiO2 ratio (PFR) from a blood sample, predicts how patients do after a lung transplant. Donor lungs with a PFR below 300 are often turned down, even when other measures look fine. The researchers reviewed 984 lung transplant recipients treated at two centers, in Leuven, Belgium and Prague, Czech Republic. They found that lower donor PFR was linked to a higher risk of severe early lung injury (primary graft dysfunction grade 3) at 24 hours after transplant. However, this link was not seen at 72 hours. Donor PFR was also not associated with acute rejection or with survival two years after transplant. This research suggests that a low donor PFR may raise the risk of early complications but may not harm longer-term outcomes, so strict use of a cutoff of 300 might exclude some usable lungs. The study was retrospective, so it shows associations rather than proof of cause, and decisions about individual donor lungs involve many other factors.

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Citation

Novysedlak R, Vanluyten C, Van Slambrouck J, Barbarossa A, Beeckmans H, Van Raemdonck D, et al.. (2026). Lower lung donor PaO2/FiO2 ratio correlates with early primary graft dysfunction, but does not impact overall survival after lung transplantation: a dual center study.. Transplant international : official journal of the European Society for Organ Transplantation. https://doi.org/10.3389/ti.2026.16414