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Lung Transplantation on Cardiopulmonary Bypass May Not Increase PGD Rates, nor Compromise Survival: A Single-Center 25-Year Review
Journal article   Peer reviewed

Lung Transplantation on Cardiopulmonary Bypass May Not Increase PGD Rates, nor Compromise Survival: A Single-Center 25-Year Review

M. Daniel, H. Kim, S. McKay, H. Zappacosta, J. Song, P. Cho, J. White, A. Abramov, D. Telesca and A. Ardehali
The Journal of heart and lung transplantation, v 45(5), pp 496-496
Apr 2026
DOI: https://doi.org/10.1016/j.healun.2026.02.1073

Abstract

Purpose: Cardiopulmonary bypass (CPB) use during lung transplantation has declined following studies associating it with higher primary graft dysfunction (PGD) and blood product utilization relative to ECMO or no support. As PGD outcomes may be influenced by patient selection and CPB strategy, we reviewed our institutional experience, where CPB remains the preferred intraoperative support. Methods: We performed a retrospective cohort analysis of all single and bilateral lung transplants at UCLA from January 2000 to May 2025. Recipients transplanted on ECMO (n=41) and multiorgan transplants were excluded. Reoperative transplants were included. Patients transplanted on CPB were compared with those transplanted without support using Chi-square and Kruskal-Wallis tests; variables with statistical significance were entered into multivariable regression. Primary endpoints were 1- and 3-year survival; secondary endpoints included PGD grade III at 72 hours, ICU and hospital length of stay, and 30-day survival. Kaplan-Meier and multivariable time-to-event analyses evaluated survival, while multivariable logistic regression assessed PGD-III. Results: Among 1618 lung transplants, 1065 (65.8%) were performed on CPB and 512 (31.6%) without support. CPB recipients were younger (57 [48-63] vs 66 [63-69]; p<0.001), had lower BMI (24.6 [21.2-28.2] vs 26.1 [23.5-28.8]; p<0.001), and higher CAS/LAS scores (p<0.001). CPB cases were predominantly bilateral (84% vs 1.2%; p<0.001) with longer ischemic times (300 vs 244 min; p<0.001). Unadjusted outcomes showed higher PGD-III (7.8% vs 3.0%; p<0.001), postoperative ECMO (5.4% vs 1.0%; p<0.001), and longer ICU and hospital stays (p<0.001). However, multivariable analysis revealed no difference in PGD-III (p=0.183) or survival at 1 year (p=0.70) and 3 years (p=0.17). Conclusion: Although unadjusted PGD-III rates were higher with CPB, adjusted analyses demonstrated no excess PGD risk or survival disadvantage. With proper patient selection and CPB management, outcomes comparable to unsupported transplantation can be achieved. Multicenter studies are warranted to further define optimal intraoperative support strategies.

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