Tags

Type your tag names separated by a space and hit enter

Clinical risk factors for primary graft dysfunction after lung transplantation.
Am J Respir Crit Care Med 2013; 187(5):527-34AJ

Abstract

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

We performed a 10-center prospective cohort study enrolled 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 from 10 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. Clinical trial registered with www.clinicaltrials.gov (NCT 00552357).

Authors+Show Affiliations

Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA. joshua.diamond@uphs.upenn.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

23306540

Citation

Diamond, Joshua M., et al. "Clinical Risk Factors for Primary Graft Dysfunction After Lung Transplantation." American Journal of Respiratory and Critical Care Medicine, vol. 187, no. 5, 2013, pp. 527-34.
Diamond JM, Lee JC, Kawut SM, et al. Clinical risk factors for primary graft dysfunction after lung transplantation. Am J Respir Crit Care Med. 2013;187(5):527-34.
Diamond, J. M., Lee, J. C., Kawut, S. M., Shah, R. J., Localio, A. R., Bellamy, S. L., ... Christie, J. D. (2013). Clinical risk factors for primary graft dysfunction after lung transplantation. American Journal of Respiratory and Critical Care Medicine, 187(5), pp. 527-34. doi:10.1164/rccm.201210-1865OC.
Diamond JM, et al. Clinical Risk Factors for Primary Graft Dysfunction After Lung Transplantation. Am J Respir Crit Care Med. 2013 Mar 1;187(5):527-34. PubMed PMID: 23306540.
* Article titles in AMA citation format should be in sentence-case
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, AU - ,, Y1 - 2013/01/10/ PY - 2013/1/12/entrez PY - 2013/1/12/pubmed PY - 2013/4/23/medline SP - 527 EP - 34 JF - American journal of respiratory and critical care medicine JO - Am. J. Respir. Crit. Care Med. VL - 187 IS - 5 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: We performed a 10-center prospective cohort study enrolled 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 from 10 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. Clinical trial registered with www.clinicaltrials.gov (NCT 00552357). SN - 1535-4970 UR - https://www.unboundmedicine.com/medline/citation/23306540/Clinical_risk_factors_for_primary_graft_dysfunction_after_lung_transplantation_ L2 - http://www.atsjournals.org/doi/full/10.1164/rccm.201210-1865OC?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -