Primary graft dysfunction (PGD) is a severe form of ischemia and reperfusion acute lung injury presenting within the first 72 hours post-lung transplant. PGD is a common surgical complication for lung transplant recipients (LTR) with an incidence of 10-25%. The 30-day mortality rate for LTR with severe PGD is reported to be higher than 50% and is the leading cause of death early post-transplant. There is a lack of data assessing treatment options for PGD. Given the significant morbidity and mortality associated with PGD, this study aims to evaluate the efficacy of bronchoscopically-administered surfactant on improving pulmonary function post-lung transplant.

Methods: A retrospective review of LTR at an academic medical center from January 1, 2010 to June 1, 2017 was conducted. All LTR who were 18 years of age or older at the time of transplant, first-time recipients, and found to have severe PGD (ISHLT Grade 2 or 3) using the alveolar-arterial oxygen gradient, PaO₂ to FiO₂ ratio, and presence of infiltrates on chest radiograph were eligible for inclusion. LTR were excluded if they received a heart-lung transplant or extracorporeal membrane oxygenation (ECMO). The primary endpoint was the effect of receiving surfactant on improving pulmonary function in LTR with severe PGD. Secondary endpoints were the effect of surfactant on 30-day and 1-year mortality.

Results: During preliminary review of 101 charts, 8 were excluded for receiving ECMO and 5 due to re-transplantation. Of the 88 remaining LTR, 51 met criteria for severe PGD with 23 receiving surfactant. These patients received an average of 2.1 doses of surfactant at 200 mg/8 mL per dose (range: 1–5 doses) an average of 3.2 days post-transplant (range: 0–13 days). At 72 hours post-surfactant administration, 11/23 (47.8%) LTR met criteria for severe PGD. At 72 hours post-transplant, 5/28 (17.8%) LTR who did not receive surfactant met criteria for severe PGD. One LTR who did not receive surfactant died within 30 days. Of the 39 LTR who received 1-year follow-up, there were 3 deaths – 1 received surfactant, 2 did not receive surfactant.

Conclusion: Bronchoscopically-administered surfactant in the setting of severe PGD did not result in improved pulmonary function compared to LTR who did not receive surfactant. Surfactant administration did not influence 30-day or 1-year mortality.

CITATION INFORMATION: Ahmed S., Soto-Arenall M., Jackson D., Erasmus D. Efficacy of Bronchoscopically-Administered Surfactant in the Setting of Primary Graft Dysfunction after Lung Transplantation Am J Transplant. 2017;17 (suppl 3).

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