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J Thorac Cardiovasc Surg 2006;132:1441-1446
© 2006 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Unilateral radiographic abnormalities after bilateral lung transplantation: Exclusion from the definition of primary graft dysfunction?

Department of Allergy, Immunology, and Respiratory Medicine, Lung Transplant Unit, The Alfred Hospital, Melbourne, Australia.

Received for publication May 24, 2006; revisions received June 26, 2006; accepted for publication August 8, 2006.

^_* Address for reprints: Gregory I. Snell, Department of Allergy, Immunology, and Respiratory Medicine, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia. (Email: g.snell{at}alfred.org.au).

OBJECTIVES: Unilateral infiltrates on chest x-ray films are occasionally seen after bilateral lung transplantation. In the primary graft dysfunction grading system, the presence or absence of a radiographic abnormality is crucial in determining the incidence and severity of primary graft dysfunction. However, no consideration is given as to whether unilateral infiltrates have the same impact and relevance as bilateral infiltrates. This study aims to describe the incidence, features, and outcomes of posttransplant unilateral infiltrates and their effect on the novel primary graft dysfunction grading system.

METHODS: Depending on posttransplant radiographic appearance, 144 patients who underwent bilateral lung transplantation were divided into 3 groups: no infiltrates (clear), unilateral infiltrates (unilateral), or bilateral infiltrates (bilateral).

RESULTS: Radiographic abnormalities were seen in 43% of donors and 61% of posttransplant recipients (sensitivity = 76%, specificity = 50%). The percentage of recipients in the unilateral, clear, and bilateral groups was 26%, 39%, and 35%, respectively. Lower posttransplant oxygenation (P < .05), longer intubation hours, and more intensive care unit days (P < .0001) were seen in the bilateral compared with the unilateral and the clear groups. A significant difference in the prevalence of primary graft dysfunction (P < .0001) was seen, depending on whether unilateral infiltrates were included or excluded from the primary graft dysfunction grading.

CONCLUSIONS: The incidence of unilateral infiltrates is relatively high after bilateral lung transplantation. The early posttransplant outcome of the unilateral infiltrates is similar to that in the group having a clear chest x-ray film and significantly better than that in those with bilateral infiltrates. In bilateral lung transplantation, only bilateral infiltrates should be used as part of the definition of primary graft dysfunction.

This article has been cited by other articles:

				T. Oto and G. I. Snell Reply to the Editor J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 270 - 271. [Full Text] [PDF]

				J. Shuhaiber Unilateral as well as bilateral infiltrates should remain part of the definition of pulmonary graft dysfunction J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 269 - 270. [Full Text] [PDF]