• Julien Fessler, Alexandre Vallée, Avit Guirimand, Edouard Sage, Matthieu Glorion, Antoine Roux, Olivier Brugière, François Parquin, Benjamin Zuber, Charles Cerf, Marc Vasse, Tiffany Pascreau, Marc Fischler, Carole Ichai, and GuenMorgan LeMLDepartment of Anesthesiology, Hôpital Foch, Suresnes, France; Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France..
• Department of Anesthesiology, Hôpital Foch, Suresnes, France; Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France. Electronic address: j.fessler@hopital-foch.com.
• J. Cardiothorac. Vasc. Anesth. 2022 Mar 1; 36 (3): 794-804.

ObjectiveMany prognostic factors of grade-3 primary graft dysfunction at postoperative day 3 (PGD3-T72) have been reported, but intraoperative blood lactate level has not been studied. The present retrospective study was done to test the hypothesis that intraoperative blood lactate level (BLL) could be a predictor of PGD3-T72 after double-lung transplantation.DesignRetrospective monocentric cohort study.SettingFoch University Hospital, Suresnes, France.ParticipantsPatients having received a double-lung transplantation between 2012 and 2019. Patients transplanted twice during the study period, having undergone a multiorgan transplantation, or cardiopulmonary bypass, and those under preoperative extracorporeal membrane oxygenation, were excluded.InterventionsNone.Measurements And Main ResultsAnalysis was performed on a cohort of 449 patients. Seventy-two (16%) patients had a PGD3-T72. Blood lactate level increased throughout surgery to reach a median value of 2.2 (1.6-3.2) mmol/L in the No-PGD3-T72 group and 3.4 (2.3-5.0) mmol/L in the PGD3-T72 group after second lung implantation. The best predictive model for PGD3-T72 was obtained adding a lactate threshold of 2.6 mmol/L at the end of surgery to the clinical model, and the area under the curve was 0.867, with a sensitivity = 76.9% and specificity = 85.4%. Repeated-measures mixed model of BLL during surgery remained significant after adjustment for covariates (F ratio= 4.22, p < 0.001 for interaction).ConclusionsBlood lactate level increases during surgery and reaches a maximum after the second lung implantation. A value below the threshold of 2.6 mmol/L at the end of surgery has a high negative predictive value for the occurrence of a grade-3 primary graft dysfunction at postoperative day 3.Copyright © 2021 Elsevier Inc. All rights reserved.

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