Prioritization itself was not independently associated with severe primary graft dysfunction after lung transplantation, suggesting that underlying disease severity and need for advanced support are the main drivers of post-transplant outcomes.
Severe primary graft dysfunction occurred more frequently among prioritized lung transplant recipients compared to non-prioritized recipients.
Prioritization status was not independently associated with severe primary graft dysfunction after adjustment for confounders.
Pre-transplant extracorporeal membrane oxygenation (ECMO) support was the strongest independent predictor of severe primary graft dysfunction.
Prioritized lung transplant recipients had higher 90-day and 1-year mortality compared to non-prioritized recipients, despite similar 30-day mortality.
Prioritized lung transplant recipients were clinically more severe at the time of transplantation than non-prioritized recipients.
This research examined whether being placed on a priority waiting list for a lung transplant increases the risk of a serious complication called primary graft dysfunction (PGD), which is when the transplanted lung fails to work properly shortly after surgery. The study looked at 310 lung transplant patients over nearly a decade at a single major transplant center. About one in four patients (23.8%) had been prioritized on the waiting list, meaning they were sicker and needed a transplant more urgently. These prioritized patients were more likely to be in the ICU before their transplant and more likely to be on life-support machines called ECMO (extracorporeal membrane oxygenation). The study found that severe PGD happened more often in prioritized patients (24%) than in non-prioritized patients (7%). However, when researchers accounted for other factors using statistical analysis, being prioritized itself was not what drove the higher PGD risk — rather, it was the underlying severity of illness, particularly the need for ECMO support before transplant, that was the strongest predictor of severe PGD. Prioritized patients also had worse survival at 90 days and one year after transplant, though their 30-day survival was similar to non-prioritized patients. This research suggests that sicker patients who need lung transplants urgently face higher risks after surgery, but this is largely because of how ill they are before transplantation — not simply because of their priority status. The findings highlight the importance of pre-transplant ECMO use as a key risk factor, which could help clinicians better anticipate complications and counsel patients about expected outcomes.
Pola Dos Reis F, Tejo A, Santos S, Vale F, Cruz V, Abdalla L, et al.. (2026). Prioritization and Severe Primary Graft Dysfunction after Lung Transplantation.. Clinical transplantation. https://doi.org/10.1111/ctr.70711