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Risk factors and survival impact of primary graft dysfunction after lung transplantation in a single institution.
Transplant Proc 2012; 44(8):2462-8TP

Abstract

BACKGROUND

Lung transplantation has become a standard procedure for some end-stage lung diseases, but primary graft dysfunction (PGD) is an inherent problem that impacts early and late outcomes. The aim of this study was to define the incidence, risk factors, and impact of mechanical ventilation time on mortality rates among a retrospective cohort of lung transplantations performed in a single institution.

METHODS

We performed a retrospective study of 118 lung transplantations performed between January 2003 and July 2010. The most severe form of PGD (grade III) as defined at 48 and 72 hours was examined for risk factors by multivariable logistic regression models using donor, recipient, and transplant variables.

RESULTS

The overall incidence of PGD at 48 hours was 19.8%, and 15.4% at 72 hours. According multivariate analysis, risk factors associated with PGD were donor smoking history for 48 hours (adjusted odds ratio [OR], 4.83; 95% confidence interval [CI], 1.236-18.896; P = .022) and older donors for 72 hours (adjusted OR, 1.046; 95% CI, 0.997-1.098; P = .022). The operative mortality was 52.9% among patients with PGD versus 20.3% at 48 hours (P = .012). At 72 hours, the mortality rate was 58.3% versus 21.2% (P = .013). The 90-days mortality was also higher among patients with PGD. The mechanical ventilation time was longer in patients with PGD III at 48 hours namely, a mean time of 72 versus 24 hours (P = .001). When PGD was defined at 72 hours, the mean ventilation time was even longer, namely 151 versus 24 hours (P < .001). The mean overall survival for patients who developed PGD at 48 hours was 490.9 versus 1665.5 days for subjects without PGD (P = .001). Considering PGD only at 72 hours, the mean survival was 177.7 days for the PGD group and 1628.9 days for the other patients (P < .001).

CONCLUSION

PGD showed an important impacts on operative and 90-day mortality rates, mechanical ventilation time, and overall survival among lung transplant patients. PGD at 72 hours was a better predictor of lung transplant outcomes than at 48 hours. The use of donors with a smoking history or of advanced age were risk factors for the development of PGD.

Authors+Show Affiliations

Lung Transplant Group, Thoracic Surgery Division of Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil. marcos.samano@incor.usp.brNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23026621

Citation

Samano, M N., et al. "Risk Factors and Survival Impact of Primary Graft Dysfunction After Lung Transplantation in a Single Institution." Transplantation Proceedings, vol. 44, no. 8, 2012, pp. 2462-8.
Samano MN, Fernandes LM, Baranauskas JC, et al. Risk factors and survival impact of primary graft dysfunction after lung transplantation in a single institution. Transplant Proc. 2012;44(8):2462-8.
Samano, M. N., Fernandes, L. M., Baranauskas, J. C., Correia, A. T., Afonso, J. E., Teixeira, R. H., ... Jatene, F. B. (2012). Risk factors and survival impact of primary graft dysfunction after lung transplantation in a single institution. Transplantation Proceedings, 44(8), pp. 2462-8. doi:10.1016/j.transproceed.2012.07.134.
Samano MN, et al. Risk Factors and Survival Impact of Primary Graft Dysfunction After Lung Transplantation in a Single Institution. Transplant Proc. 2012;44(8):2462-8. PubMed PMID: 23026621.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors and survival impact of primary graft dysfunction after lung transplantation in a single institution. AU - Samano,M N, AU - Fernandes,L M, AU - Baranauskas,J C B, AU - Correia,A T, AU - Afonso,J E,Jr AU - Teixeira,R H O B, AU - Caramori,M L, AU - Pêgo-Fernandes,P M, AU - Jatene,F B, PY - 2012/10/3/entrez PY - 2012/10/3/pubmed PY - 2013/3/13/medline SP - 2462 EP - 8 JF - Transplantation proceedings JO - Transplant. Proc. VL - 44 IS - 8 N2 - BACKGROUND: Lung transplantation has become a standard procedure for some end-stage lung diseases, but primary graft dysfunction (PGD) is an inherent problem that impacts early and late outcomes. The aim of this study was to define the incidence, risk factors, and impact of mechanical ventilation time on mortality rates among a retrospective cohort of lung transplantations performed in a single institution. METHODS: We performed a retrospective study of 118 lung transplantations performed between January 2003 and July 2010. The most severe form of PGD (grade III) as defined at 48 and 72 hours was examined for risk factors by multivariable logistic regression models using donor, recipient, and transplant variables. RESULTS: The overall incidence of PGD at 48 hours was 19.8%, and 15.4% at 72 hours. According multivariate analysis, risk factors associated with PGD were donor smoking history for 48 hours (adjusted odds ratio [OR], 4.83; 95% confidence interval [CI], 1.236-18.896; P = .022) and older donors for 72 hours (adjusted OR, 1.046; 95% CI, 0.997-1.098; P = .022). The operative mortality was 52.9% among patients with PGD versus 20.3% at 48 hours (P = .012). At 72 hours, the mortality rate was 58.3% versus 21.2% (P = .013). The 90-days mortality was also higher among patients with PGD. The mechanical ventilation time was longer in patients with PGD III at 48 hours namely, a mean time of 72 versus 24 hours (P = .001). When PGD was defined at 72 hours, the mean ventilation time was even longer, namely 151 versus 24 hours (P < .001). The mean overall survival for patients who developed PGD at 48 hours was 490.9 versus 1665.5 days for subjects without PGD (P = .001). Considering PGD only at 72 hours, the mean survival was 177.7 days for the PGD group and 1628.9 days for the other patients (P < .001). CONCLUSION: PGD showed an important impacts on operative and 90-day mortality rates, mechanical ventilation time, and overall survival among lung transplant patients. PGD at 72 hours was a better predictor of lung transplant outcomes than at 48 hours. The use of donors with a smoking history or of advanced age were risk factors for the development of PGD. SN - 1873-2623 UR - https://www.unboundmedicine.com/medline/citation/23026621/Risk_factors_and_survival_impact_of_primary_graft_dysfunction_after_lung_transplantation_in_a_single_institution_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(12)00833-0 DB - PRIME DP - Unbound Medicine ER -