Prolonged Invasive Mechanical Ventilation is Associated With Decreased Survival After Lung Transplantation Among Recipients With Primary Graft Dysfunction

Authors

• Meghan Aversa, University of Toronto
• Shaf Keshavjee, University of Toronto
• Tereza Martinu, University of Toronto
• Marcelo Cypel, University of Toronto
• Andrew T. Sage, University of Toronto
• Joshua M. Diamond, University of Pennsylvania
• Jonathan P. Singer, University of California San Francisco
• Scott M. Palmer, Duke University
• Krishna Pandya, University of Pennsylvania
• Edward Cantu, University of Kentucky
• Jason D. Christie, University of Pennsylvania
• Michaela R. Anderson, University of PennsylvaniaFollow

Abstract

Introduction: Prolonged invasive mechanical ventilation (IMV) after lung transplantation is an appealing early prognostic outcome as it can be reproducibly assessed both prospectively and retrospectively. Whether use of IMV at 72 h after lung transplantation is associated with post-transplant graft survival is unknown. Methods: We performed a retrospective cohort study of 1511 participants in the multi-center Lung Transplant Outcomes Group cohort (2011–2018). Using Cox proportional hazards models and restricted mean survival time, we investigated whether IMV at 72 h was associated with post-transplant graft survival. We secondarily evaluated whether IMV at 72 h was concordant with severe primary graft dysfunction (PGD). Results: Participants requiring IMV at 72 h after transplant were sicker at transplantation (higher lung allocation score [LAS], increased extracorporeal membrane oxygenation, or IMV bridge) and more likely to have severe PGD. Use of IMV at 72 h was associated with 55% (95% CI 26%–92%) increased hazards of death or re-transplantation after adjustment for age, ECMO, diagnosis, LAS, and intra-operative transfusion. The association between IMV and graft survival was modified by severe PGD (p-for interaction 0.002) but not by pre-transplant ECMO (p-for interaction 0.88) or pre-transplant IMV (p-for interaction 0.92). IMV was associated with increased risk of death or re-transplantation among those with PGD (HR 2.35, 95% CI 1.43–3.85) but not among those without PGD (HR 1.04, 95% CI 0.77-1.41). Conclusion: Requirement of IMV at 72 h is an important early post-transplant outcome associated with post-transplant survival. This appears driven by those with severe PGD.

Document Type

Article

Publication Date

1-1-2026

Notes/Citation Information

Publisher Copyright: © 2026 The Author(s). Clinical Transplantation published by Wiley Periodicals LLC.

Digital Object Identifier (DOI)

10.1111/ctr.70447

Archival?

Archival

Repository Citation

Aversa, Meghan; Keshavjee, Shaf; Martinu, Tereza; Cypel, Marcelo; Sage, Andrew T.; Diamond, Joshua M.; Singer, Jonathan P.; Palmer, Scott M.; Pandya, Krishna; Cantu, Edward; Christie, Jason D.; and Anderson, Michaela R., "Prolonged Invasive Mechanical Ventilation is Associated With Decreased Survival After Lung Transplantation Among Recipients With Primary Graft Dysfunction" (2026). Surgery Faculty Publications. 62.
https://uknowledge.uky.edu/surgery_facpub/62