Key Point

For reasons not yet understood, women are at significantly greater risk than men for developing primary graft dysfunction after lung transplantation.

SAN DIEGO—Primary graft dysfunction—an acute, severe lung injury that usually occurs in the first 72 hours after surgery—is one of the most serious complications of lung transplantation and carries a high mortality risk.

At the annual meeting of the American Thoracic Society, Jason D. Christie, MD, MS, Assistant Professor of Medicine and Epidemiology at the University of Pennsylvania School of Medicine in Philadelphia, presented the results of a cohort study that he and his colleague Catherine Kuntz, MD, undertook. They found that women who received lung transplants, regardless of donor gender, were 60% more likely to experience primary graft dysfunction compared with men who received lungs from male donors.¹

The United Network for Organ Sharing/International Society of Heart and Lung Transplantation (UNOS/ISHLT) registry contains data for 7,482 lung transplants performed in the United States between 1994 and 2002. Using multivariate logistic regression, the investigators assessed the risk of female donor and recipient sex in the development of primary graft dysfunction.

DONOR GENDER NOT A FACTOR

Overall, 10% of recipients had primary graft dysfunction. However, female transplant recipients were at increased risk of primary graft dysfunction even after adjustment for confounders. In the univariate analysis, female donor sex was associated with an increased risk of primary graft dysfunction. These associations lost significance in the multivariate model.

Compared with male donor/male recipient transplants, the development of primary graft dysfunction in female donor/female recipient transplants was associated with an odds ratio of 1.68. Similarly, male donor/female recipient transplants had an odds ratio of 1.66, whereas female donor/male recipient transplants had an odds ratio of 1.19.

Thus, the risk for primary graft dysfunction in women receiving lung transplants occurs independent of the combination of donor and recipient sex. “We need carefully conducted cohort studies to look at the reasons why this is the case,” noted Dr. Christie. There are a lot of theories but not a lot of science behind them, he added.

Lung transplants are performed without consideration for the gender of the donor or the recipient, Dr. Christie explained. By looking at the subgroups from the possible combinations of donor-recipient gender, one can then look at the effects of these combinations. Understanding the causes of primary graft dysfunction is important to both early and long-term outcomes in lung transplant patients.

—Gale Jurasek

Reference
1. Kuntz CJ, Christie JD. Recipient female sex is a risk factor for development of primary graft dysfunction after lung transplantation. Presented at: annual meeting of the American Thoracic Society, May 24, 2005; San Diego, Calif.

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