Objectives: To identify the various risk factors for early (90 day) mortality after lung transplantation and to evaluate the relationship between lung injury and postoperative survival. Methods: 152 recipients of single (100) or bilateral (52) lung allografts were evaluated for the presence of postoperative lung injury assessed by a composite four-component lung injury score. Preoperative variables, postoperative course, and mortality were reviewed retrospectively. Results: There was a high risk of death during the first 90 d after transplantation, followed by a decline in risk during the remainder of the first postoperative year. By univariate analysis, lung injury score (p = 0.000 I), chest radiograph score (p = 0.000 I), and hypoxemia (Pa02lFI02) ratio (p =0.0002) were the most statistically significant risk factors for 90-day mortality. Other parameters such as length of intensive care stay (p = 0.0175), length of intubation (p = 0.0212), and preoperative diagnosis of pulmonary fibrosis (p = 0.0123) were also significant risk factors for 90-day mortality. By multivariable analysis, only lung injury score (p = 0.000 I) was a statistically significant risk factor for 90-day mortality. The risk of 90-day mortality increased by a factor of 4.4 for each I point increment in lung injury score. However, none of the analyzed preoperative or postoperative variables were able to statistically predict lung injury score. Conclusions: Postoperative lung injury is the most important risk factor for early postoperative mortality after lung transplantation.

Keywords: Transplantation, Allograft, Ischemic time, Lung Injury