TY - JOUR
T1 - Clinical risk factors for primary graft dysfunction after lung transplantation
AU - Diamond, Joshua M.
AU - Lee, James C.
AU - Kawut, Steven M.
AU - Shah, Rupal J.
AU - Localio, A. Russell
AU - Bellamy, Scarlett L.
AU - Lederer, David J.
AU - Cantu, Edward
AU - Kohl, Benjamin A.
AU - Lama, Vibha N.
AU - Bhorade, Sangeeta M.
AU - Crespo, Maria
AU - Demissie, Ejigayehu
AU - Sonett, Joshua
AU - Wille, Keith
AU - Orens, Jonathan
AU - Shah, Ashish S.
AU - Weinacker, Ann
AU - Arcasoy, Selim
AU - Shah, Pali D.
AU - Wilkes, David S.
AU - Ware, Lorraine B.
AU - Palmer, Scott M.
AU - Christie, Jason D.
PY - 2013/3/1
Y1 - 2013/3/1
N2 - Rationale: Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors. Objectives: We sought to identify donor, recipient, and perioperative risk factors for PGD. Methods: Weperformeda 10-center prospective cohort studyenrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was International Society for Heart and Lung Transplantation grade 3 PGD at 48 or 72 hours post-transplant. The association of potential risk factors with PGD was analyzed using multivariable conditional logistic regression. Measurements and Main Results: A total of 1,255 patients from10 centers were enrolled; 211 subjects (16.8%) developed grade 3 PGD. In multivariable models, independent risk factors for PGD were any history of donor smoking (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.6; P = 0.002); FIO2 during allograft reperfusion (OR, 1.1 per 10% increase in FIO2; 95% CI, 1.0-1.2; P = 0.01); single lung transplant (OR, 2; 95%CI, 1.2-3.3;P=0.008);use of cardiopulmonary bypass(OR,3.4;95%CI, 2.2-5.3; P < 0.001); overweight (OR, 1.8; 95% CI, 1.2-2.7; P = 0.01) and obese (OR, 2.3; 95% CI, 1.3-3.9; P = 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1-5.6; P = 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6-7.7; P = 0.002); and mean pulmonary artery pressure (OR, 1.3 per 10 mm Hg increase; 95%CI, 1.1-1.5;P < 0.001).PGD was significantly associated with 90-day (relative risk, 4.8; absolute risk increase, 18%; P < 0.001) and 1-year (relative risk, 3; absolute risk increase, 23%; P < 0.001) mortality. Conclusions: We identified grade 3 PGD risk factors, several of which are potentially modifiable and should be prioritized for future research aimed at preventative strategies.
AB - Rationale: Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors. Objectives: We sought to identify donor, recipient, and perioperative risk factors for PGD. Methods: Weperformeda 10-center prospective cohort studyenrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was International Society for Heart and Lung Transplantation grade 3 PGD at 48 or 72 hours post-transplant. The association of potential risk factors with PGD was analyzed using multivariable conditional logistic regression. Measurements and Main Results: A total of 1,255 patients from10 centers were enrolled; 211 subjects (16.8%) developed grade 3 PGD. In multivariable models, independent risk factors for PGD were any history of donor smoking (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.6; P = 0.002); FIO2 during allograft reperfusion (OR, 1.1 per 10% increase in FIO2; 95% CI, 1.0-1.2; P = 0.01); single lung transplant (OR, 2; 95%CI, 1.2-3.3;P=0.008);use of cardiopulmonary bypass(OR,3.4;95%CI, 2.2-5.3; P < 0.001); overweight (OR, 1.8; 95% CI, 1.2-2.7; P = 0.01) and obese (OR, 2.3; 95% CI, 1.3-3.9; P = 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1-5.6; P = 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6-7.7; P = 0.002); and mean pulmonary artery pressure (OR, 1.3 per 10 mm Hg increase; 95%CI, 1.1-1.5;P < 0.001).PGD was significantly associated with 90-day (relative risk, 4.8; absolute risk increase, 18%; P < 0.001) and 1-year (relative risk, 3; absolute risk increase, 23%; P < 0.001) mortality. Conclusions: We identified grade 3 PGD risk factors, several of which are potentially modifiable and should be prioritized for future research aimed at preventative strategies.
KW - Clinical risk factors
KW - Lung transplantation
KW - Primary graft dysfunction
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U2 - 10.1164/rccm.201210-1865OC
DO - 10.1164/rccm.201210-1865OC
M3 - Article
C2 - 23306540
AN - SCOPUS:84875169517
SN - 1073-449X
VL - 187
SP - 527
EP - 534
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 5
ER -