Postoperative Estradiol Levels Associate With Development of Primary Graft Dysfunction in Lung Transplantation Patients

BackgroundPrimary graft dysfunction (PGD) frequently complicates lung transplantation in the immediate postoperative period. Both female gender and estradiol modulate the body's response to injury and can influence the rate of alveolar fluid clearance.ObjectiveWe hypothesized that female gender and higher estradiol levels would be associated with a lower risk of PGD after lung transplantation.MethodsWe measured plasma estradiol levels preoperatively, 6 hours postoperatively, and 24 hours postoperatively in a cohort of 111 lung transplant recipients at 2 institutions.ResultsMean age was 57 years (12.5) and 52% were female. Median postoperative estradiol level was 63.9 pg/mL (interquartile range, 28.8−154.3 pg/mL) in male and 65.1 pg/mL (interquartile range, 28.4−217.2 pg/mL) in female patients. Contrary to our hypothesis, higher estradiol levels at 24 hours were associated with an increased risk of PGD at 72 hours in male patients (P = 0.001). This association was preserved when accounting for other factors known to be associated with PGD. However, there was no relationship between gender and risk of PGD or between estradiol levels and PGD in females.ConclusionThese findings suggest that there might be different biologic effects of estrogens in males and females, and highlight the importance of considering gender differences in future studies of PGD.