<?xml version="1.1" encoding="utf-8"?>
<article xsi:noNamespaceSchemaLocation="http://jats.nlm.nih.gov/publishing/1.1/xsd/JATS-journalpublishing1-mathml3.xsd" dtd-version="1.1" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"><front><journal-meta><journal-id journal-id-type="publisher-id">JCNR</journal-id><journal-title-group><journal-title>Journal of Clinical and Nursing Research</journal-title></journal-title-group><issn>2208-3685</issn><eissn>2208-3693</eissn><publisher><publisher-name>Bio-Byword Scientific Publishing Pty. Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.26689/jcnr.v9i11.12912</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title>Trajectory and Influencing Factors of Postoperative Vulnerable Symptom Clusters in Lung Transplant Recipients</title><url>https://artdesignp.com/journal/JCNR/9/11/10.26689/jcnr.v9i11.12912</url><author>LiXue,JinYing,HuJing,DingJunrong</author><pub-date pub-type="publication-year"><year>2025</year></pub-date><volume>9</volume><issue>11</issue><history><date date-type="pub"><published-time>2025-12-08</published-time></date></history><abstract>The first three months after lung transplantation are the clinical “vulnerable period”. Complications during this period often appear in the form of symptom clusters. The core includes primary graft dysfunction (PGD), infection, inflammatory response and multiple organ dysfunction, and are interconnected to form a complex network. The symptom cluster shows a clear dynamic trajectory: the risk of PGD peaks at 24 hours after surgery, and its evolution trajectory (recovery, delay, deterioration) directly affects long-term graft function; infections show a “double peak distribution”, with bacteria/fungi dominant in the early stage (&amp;lt; 1 month) and viruses/opportunistic infections dominant in the middle stage (1–6 months), and promote each other with PGD. Influencing factors include four dimensions: donor (smoking history, infection), recipient (weakness, immune status), perioperative period (surgical method, support strategy) and postoperative management (balance of immunosuppression). In the future, dynamic prediction models and individualized management paths need to be built to improve patient outcomes.</abstract><keywords/></article-meta></front><body/><back><ref-list><ref id="B1" content-type="article"><label>1</label><element-citation publication-type="journal"><p>Abey A, Singh M, Abraham M, et al., 2023, Epidemiology and long-term outcomes in thoracic transplantation. Journal of Cardiovascular Development and Disease, 10(9): 397.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B2" content-type="article"><label>2</label><element-citation publication-type="journal"><p>Criner R, Clausen E, Cantu E, 2021, Primary graft dysfunction. Current Opinion in Organ Transplantation, 26(3): 321–327.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B3" content-type="article"><label>3</label><element-citation publication-type="journal"><p>Onyearugbulem C, Williams L, Zhu H, et al., 2018, Risk factors for infection after pediatric lung transplantation. Transplant Infectious Disease, 20(6): e13000.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B4" content-type="article"><label>4</label><element-citation publication-type="journal"><p>Wu B, Hu C, Li X, et al., 2021, Life first, respect for science: current status and prospect of lung transplantation in China. Journal of Wuhan University (Medical Sciences), 42(4): 517–519.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B5" content-type="article"><label>5</label><element-citation publication-type="journal"><p>Geraci T, Chan J, Niroomand A, et al., 2025, Post lung transplant primary graft dysfunction. Seminars in Thoracic and Cardiovascular Surgery, 37(2): 192–198.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B6" content-type="article"><label>6</label><element-citation publication-type="journal"><p>Li M, Yang H, Gao R, 2024, A review of postoperative symptom clusters in solid organ transplant patients. Journal of Nurses Training, 39(14): 1476–1481.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B7" content-type="article"><label>7</label><element-citation publication-type="journal"><p>Roussel A, Sage E, Massard G, et al., 2019, Impact of donor, recipient and matching on survival after high-emergency lung transplantation in France. European Respiratory Journal, 54(5): 1900096.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B8" content-type="article"><label>8</label><element-citation publication-type="journal"><p>Yamaguchi M, Kawashima M, Muraoka T, et al., 2024, Baseline lung allograft dysfunction after bilateral deceased-donor lung transplantation: a single-center experience in Japan. Respiratory Investigation, 62(5): 838–843.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B9" content-type="article"><label>9</label><element-citation publication-type="journal"><p>Roussel A, Sage E, Falcoz P, et al., 2024, Survival outcomes following urgent lung transplantation in France and the USA. Thorax, 79(8): 745–753.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B10" content-type="article"><label>10</label><element-citation publication-type="journal"><p>Liu J, Jackson K, Weinkauf J, et al., 2018, Baseline lung allograft dysfunction and impaired survival after double-lung transplantation. Journal of Heart and Lung Transplantation, 37(7): 895–902.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B11" content-type="article"><label>11</label><element-citation publication-type="journal"><p>Wang D, Xu Z, Wang H, et al., 2025, Experience with ECMO in 29 lung transplantation cases in a single center. Chinese Journal of Extracorporeal Circulation, 23(3): 219–224.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B12" content-type="article"><label>12</label><element-citation publication-type="journal"><p>Li D, Weinkauf J, Kapasi A, et al., 2021, Baseline lung allograft dysfunction in primary graft dysfunction survivors after lung transplantation. Respiratory Medicine, 188: 106617.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B13" content-type="article"><label>13</label><element-citation publication-type="journal"><p>Snell G, Yusen R, Weill D, et al., 2017, ISHLT consensus statement on primary lung graft dysfunction: Part I — definition and grading. Journal of Heart and Lung Transplantation, 36(10): 1097–1103.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B14" content-type="article"><label>14</label><element-citation publication-type="journal"><p>Moraes J, Oliveira R, Samano M, et al., 2020, Risk factors for surgical site infection following lung transplant. Progress in Transplantation, 30(4): 329–334.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B15" content-type="article"><label>15</label><element-citation publication-type="journal"><p>Gagliotti C, Morsillo F, Moro M, et al., 2018, Infections in liver and lung transplant recipients: a national prospective cohort. European Journal of Clinical Microbiology &amp; Infectious Diseases, 37(3): 399–407.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B16" content-type="article"><label>16</label><element-citation publication-type="journal"><p>Coiffard B, Prud’Homme E, Hraiech S, et al., 2020, Worldwide perioperative antibiotic practices for lung transplantation. BMC Pulmonary Medicine, 20(1): 109.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B17" content-type="article"><label>17</label><element-citation publication-type="journal"><p>Dettori M, Riccardi N, Canetti D, et al., 2024, Infections in lung-transplanted patients: a review. Pulmonology, 30(3): 287–304.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B18" content-type="article"><label>18</label><element-citation publication-type="journal"><p>Xiong M, Li X, Qian T, et al., 2024, Respiratory viral infection after lung transplantation: current status and strategies. Organ Transplantation, 15(6): 970–976.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B19" content-type="article"><label>19</label><element-citation publication-type="journal"><p>Huang M, Sui M, Hu C, et al., 2025, Diagnosis and treatment of acute kidney injury after lung transplantation. Organ Transplantation, 16(2): 322–328.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B20" content-type="article"><label>20</label><element-citation publication-type="journal"><p>Wajda-Pokrontka M, Nadziakiewicz P, Krauchuk A, et al., 2022, Acute kidney injury among lung transplant recipients: incidence and perioperative risk factors. Transplantation Proceedings, 54(4): 1120–1123.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B21" content-type="article"><label>21</label><element-citation publication-type="journal"><p>Girgis R, Hadley R, Murphy E, 2023, Pulmonary, circulatory and renal considerations in early postoperative lung transplant care. Global Cardiology Science &amp; Practice, 2023(3): e202318.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B22" content-type="article"><label>22</label><element-citation publication-type="journal"><p>Qian T, Li X, Wang W, et al., 2023, Risk factors for pulmonary bacterial infection after lung transplantation and their impact on mortality. Journal of Southeast University (Medical Edition), 42(3): 348–356.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B23" content-type="article"><label>23</label><element-citation publication-type="journal"><p>Small B, Gomes M, McCurry K, et al., 2020, Diagnostic algorithm for heparin-induced thrombocytopenia in lung transplant recipients. Progress in Transplantation, 30(1): 4–12.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B24" content-type="article"><label>24</label><element-citation publication-type="journal"><p>Zheng M, Yousef I, Mamary A, et al., 2021, Venous thromboembolism in lung transplant recipients: experience from a high-volume center. Journal of Heart and Lung Transplantation, 40(10): 1145–1152.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B25" content-type="article"><label>25</label><element-citation publication-type="journal"><p>Zheng M, Yousef I, Mamary A, et al., 2021, Venous thromboembolism in lung transplant recipients: experience from a high-volume center. Journal of Heart and Lung Transplantation, 40(10): 1145–1152.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B26" content-type="article"><label>26</label><element-citation publication-type="journal"><p>Olejniczack M, Jackson S, Richardson S, et al., 2021, Predictors of primary graft dysfunction following bilateral lung transplantation. Journal of Heart and Lung Transplantation, 40(4 Suppl): S380–S381.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B27" content-type="article"><label>27</label><element-citation publication-type="journal"><p>Adam D, Landry C, Corado-Castillo D, et al., 2020, Donor phenotypes and biomarkers associated with primary graft dysfunction in lung transplant recipients. Journal of Heart and Lung Transplantation, 39(4 Suppl): S328.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B28" content-type="article"><label>28</label><element-citation publication-type="journal"><p>Jennekens J, Braithwaite S, Luijk B, et al., 2025, Primary graft dysfunction in lung transplantation: molecular mechanisms overview. International Journal of Molecular Sciences, 26(14): 6776.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B29" content-type="article"><label>29</label><element-citation publication-type="journal"><p>Undurraga M, Vega S, Fajardo C, et al., 2021, Lung transplant with ex vivo lung perfusion: Chilean and Latin American first experience. Revista Medica de Chile, 149(2): 171–177.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B30" content-type="article"><label>30</label><element-citation publication-type="journal"><p>Gouchoe D, Cui E, Satija D, et al., 2024, Ex vivo lung perfusion and primary graft dysfunction: UNOS database analysis. Journal of Clinical Medicine, 13(15): 4440.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B31" content-type="article"><label>31</label><element-citation publication-type="journal"><p>Landry C, Adam D, Privé A, et al., 2021, Alveolar epithelial damage in ischemia–reperfusion injury and primary graft dysfunction. Journal of Heart and Lung Transplantation, 40(4 Suppl): S379.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B32" content-type="article"><label>32</label><element-citation publication-type="journal"><p>Hu C, Yu H, Wang J, et al., 2021, Research progress on primary graft dysfunction after lung transplantation. Organ Transplantation, 12(3): 357–362.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B33" content-type="article"><label>33</label><element-citation publication-type="journal"><p>McCort M, MacKenzie E, Pursell K, et al., 2021, Bacterial infections in lung transplantation. Journal of Thoracic Disease, 13(11): 6654–6672.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B34" content-type="article"><label>34</label><element-citation publication-type="journal"><p>Atagun G, Uygun Y, 2022, Bronchial culture growth predicting graft dysfunction and pneumonia after lung transplant. Experimental and Clinical Transplantation, 20(10): 930–936.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B35" content-type="article"><label>35</label><element-citation publication-type="journal"><p>Carugati M, Arif S, Reynolds J, et al., 2025, Invasive surgical site infections after lung transplantation. JHLT Open, 9: 100294.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B36" content-type="article"><label>36</label><element-citation publication-type="journal"><p>Clouse J, Kubal C, Fridell J, et al., 2018, Complications in pediatric intestine transplantation. Pediatric Transplantation, 22(3): e13164.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B37" content-type="article"><label>37</label><element-citation publication-type="journal"><p>Hemmersbach-Miller M, Alexander B, Pieper C, et al., 2020, Older age as a risk factor for CMV reactivation in kidney transplant recipients. European Journal of Clinical Microbiology &amp; Infectious Diseases, 39(3): 455–463.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B38" content-type="article"><label>38</label><element-citation publication-type="journal"><p>Janeela A, Fouzia N, Zachariah U, 2024, Post-transplant lymphoproliferative disorder in liver transplant recipients. Journal of Clinical and Experimental Hepatology, 14(2): 101286.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B39" content-type="article"><label>39</label><element-citation publication-type="journal"><p>Ju C, Wang X, Xu X, et al., 2022, CMV seroprevalence and disease in Chinese thoracic organ transplant recipients. BMC Infectious Diseases, 22(1): 872.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B40" content-type="article"><label>40</label><element-citation publication-type="journal"><p>Balani S, Sadiq S, Jensen C, et al., 2023, Prevention and management of CMV infection in pediatric solid organ transplant recipients. Frontiers in Pediatrics, 11: 1098434.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B41" content-type="article"><label>41</label><element-citation publication-type="journal"><p>Allen U, Preiksaitis J, 2009, Epstein–Barr virus and PTLD in solid organ transplant recipients. American Journal of Transplantation, 9(S4): S87–96.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B42" content-type="article"><label>42</label><element-citation publication-type="journal"><p>Kececi O, Ozdil A, Korkmaz P, et al., 2024, Multiple life-threatening complications after lung transplantation for cystic fibrosis. Therapeutic Advances in Pulmonary and Critical Care Medicine, 19: 29768675241302903.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B43" content-type="article"><label>43</label><element-citation publication-type="journal"><p>Solé A, Morant P, Salavert M, et al., 2005, Aspergillus infections in lung transplant recipients. Clinical Microbiology and Infection, 11(5): 359–365.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B44" content-type="article"><label>44</label><element-citation publication-type="journal"><p>Wang W, Li X, Qian T, et al., 2023, Risk factors for invasive fungal infection after lung transplantation. Journal of Southeast University (Medical Edition), 42(1): 132–139.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B45" content-type="article"><label>45</label><element-citation publication-type="journal"><p>Mallet M, Todesco A, Drevet G, et al., 2025, Postoperative acute kidney injury requiring dialysis after lung transplantation. European Journal of Cardio-thoracic Surgery, 67(8): ezaf247.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B46" content-type="article"><label>46</label><element-citation publication-type="journal"><p>Mehew J, Hogg R, Clark S, et al., 2023, Prolonged ischemic time and CPB use during lung transplantation. Journal of Heart and Lung Transplantation, 42(10): 1378–1396.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B47" content-type="article"><label>47</label><element-citation publication-type="journal"><p>Schaenman J, Lum J, Arif S, et al., 2025, Frailty predicting post-transplant outcomes in lung transplant candidates. American Journal of Transplantation, 25(8): S505.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B48" content-type="article"><label>48</label><element-citation publication-type="journal"><p>Zhang C, Wang Q, Lu A, 2024, ECMO for bridging lung transplantation. European Journal of Medical Research, 29(1): 628.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B49" content-type="article"><label>49</label><element-citation publication-type="journal"><p>Kleid L, Walter J, Moehnle P, et al., 2024, High-risk HLA-DQ mismatches and adverse lung transplant outcomes. Transplant International, 37: 13010.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B50" content-type="article"><label>50</label><element-citation publication-type="journal"><p>Da Nobrega R, Passos F, Pessoa B, 2025, ECMO vs CPB in lung transplantation: updated meta-analysis. General Thoracic and Cardiovascular Surgery, 73(3): 137–146.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B51" content-type="article"><label>51</label><element-citation publication-type="journal"><p>Syrett A, Huang A, 2020, Transfusion and primary graft dysfunction: role of ratios. Journal of Cardiothoracic and Vascular Anesthesia, 34(11): 3033–3035.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B52" content-type="article"><label>52</label><element-citation publication-type="journal"><p>Loor G, Huddleston S, Hartwig M, et al., 2022, Effect of intraoperative support mode on primary graft dysfunction. Journal of Thoracic and Cardiovascular Surgery, 164(5): 1351–1361.e4.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B53" content-type="article"><label>53</label><element-citation publication-type="journal"><p>Righi I, Barone I, Rosso L, et al., 2024, Immunopathology of lung transplantation. Frontiers in Immunology, 15: 1433469.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B54" content-type="article"><label>54</label><element-citation publication-type="journal"><p>Kawashima M, Ma J, Huszti E, et al., 2024, CMV viremia and long-term outcomes in lung transplant recipients. American Journal of Transplantation, 24(6): 1057–1069.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B55" content-type="article"><label>55</label><element-citation publication-type="journal"><p>Gemert J, Fleurke G, Akkerman O, et al., 2025, Aspergillus after lung transplantation: prophylaxis, risk factors, and CLAD impact. Transplant Infectious Disease, 27(4): e70020.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B56" content-type="article"><label>56</label><element-citation publication-type="journal"><p>Evans K, Beermann K, Lee H, et al., 2022, Tacrolimus trough variability and acute rejection after lung transplantation. Transplantation Proceedings, 54(8): 2270–2276.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B57" content-type="article"><label>57</label><element-citation publication-type="journal"><p>Chinese Society of Organ Transplantation, 2019, Guidelines for immunosuppressive therapy and rejection in lung transplantation (2019 edition). Chinese Journal of Transplantation (Electronic Edition), 13(2): 94–98.</p><pub-id pub-id-type="doi"/></element-citation></ref></ref-list></back></article>
