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PRIMARY GRAFT DYSFUNCTION AFTER LUNG TRANSPLANT WITH T-CELL DEPLETION

The objective of the study is to determine whether T cell depletion through pretreatment with either Thymoglobulin or Campath influences the incidence and severity of PGD (primary graft dysfunction) after human lung transplantation.This is a single center study, conducted between July 2000 and November 2004, and is a retrospective analysis of 206 patients. Patients received one of following forms of induction therapy: Zenapax (n=28), Thymoglobulin (n=37), Campath (n=76), or no induction (n=65) therapy. Donor and recipient demographic, operative information, and survival data were collected. Assignment of primary grading dysfunction (PGD) grading was based on the International Society for Heart and Lung Transplantation (ISHLT) grading guidelines.While baseline characteristics were similar for most variables, grafts for patients that received Campath (293±64 min) or Thymoglobulin (282±66 min) had a longer duration of ischemic time compared to the control group, no induction therapy (246±65 min). A significant difference between Campath (78.9%) and no induction (92.3%) group was observed with a p-value of 0.047 for the overall severity of PGD. In the multivariate analysis, Perfadex (p=0.009, OR=0.31), the preservation solution, remained as a protective agent on preventing recipients from severe PGD, and use of CPB (cardiopulmonary bypass) (p<<0.001, OR=4.53) was identified to be a statistically significant risk factor for development of grade 3 PGD. There was improved early oxygenation and improved one year survival in patients that received Campath compared to the control group.The combined use of Campath as induction therapy and the graft preservation solution of Perfadex seem to be protective against the development of grade 3 PGD as their roles on defending cumulative incidence of PGD were hindered. The use of CPB was an independent risk factor to the development of grade 3 PGD. These results suggest that the development of PGD after human lung transplantation is mainly due to intrinsic immune or non-immune mechanisms, further study will be necessary to unravel the role of T cells, and it will have significant impact on public health relevance application.