The PGD consensus definition can be simplified by combining lower PGD grades. Construct validity of grading was present regardless of transplant procedure type or use of mechanical ventilation. Additional severity categories had minimal impact on mortality or biomarker discrimination.

Objective Donor blood transfusion has been identified as a potential risk factor for primary graft dysfunction and by extension early mortality. We sought to define the contributing risk of donor transfusion on early mortality for lung transplant. Methods Donor and recipient data were abstracted from the OPTN database updated through 6/30/14, which included 86,398 potential donors and 16,255 transplants. Using the UNOS 4-level designation of transfusion (no blood, 1–5 units, 6–10 units, and >10 units - massive), all-cause mortality at 30-days was analyzed using logistic regression adjusted for confounders (ischemic time, donor age, recipient diagnosis, LAS and recipient age and recipient BMI). Secondary analyses assessed 90-day, 1-year mortality and hospital length of stay. Results Of the 16,255 recipients transplanted, 8,835 (54.35%) donors received at least one transfusion. Among those transfused, 1,016 (6.25%) received a massive transfusion, defined as >10 units. Those donors with massive transfusion were most commonly young trauma patients. Following adjustment for confounding variables, donor massive transfusion was significantly associated with an increased risk in 30-day (p = .03) and 90-day recipient mortality (p= 0.01) but not 1-year mortality (p = 0.09). There was no significant difference in recipient length of stay or hospital free days with respect to donor transfusion. Conclusions Massive donor blood transfusion (>10 units) was associated with early recipient mortality after lung transplantation. Conversely, sub-massive donor transfusion was not associated with increased recipient mortality. The mechanism of increased early mortality in recipients of lungs from massively transfused donors is unclear and needs further study, but is consistent with excess mortality seen with primary graft dysfunction in the first 90 days post-transplant.

EVLP system provides a platform to understand the kinetics of pulmonary EVs in an isolated fashion. Donor lung recovery may be associated with changes in EV size distribution and proteomic profiles. Pulmonary tissue-specific EV profiling using the EVLP system may provide insights into EV contribution to pulmonary pathologic processes.

transfusion were most commonly younger trauma patients. Following adjustment for confounding variables, massive transfusion was significantly associated with an increased risk in 30-day (OR = 1.41; CI 1.03, 1.92; p-value = .03) and 90-day mortality (OR = 1.36; CI 1.06, 1.73; p-value = .01) but not 1 year mortality (OR = 1.17; CI 0.97, 1.41; p-value = .11). There was no significant difference in length of stay or hospital free days with respect to donor transfusion. Conclusion: Massive donor blood transfusion (> 10 units) increases early mortality after lung transplantation. Conversely, sub-massive donor transfusion does not increase donor risk. The mechanism of increased early mortality in massively transfused donors is unclear but is consistent with increased mortality risk seen with primary graft dysfunction.

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