Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

被引：522

作者：

Diamond, Joshua M. ^{[1
]}

Lee, James C. ^{[1
]}

Kawut, Steven M. ^{[1
,2
,3
]}

Shah, Rupal J. ^{[1
]}

Localio, A. Russell ^{[2
]}

Bellamy, Scarlett L. ^{[2
]}

Lederer, David. J. ^{[6
]}

Cantu, Edward ^{[4
]}

Kohl, Benjamin A. ^{[5
]}

Lama, Vibha N. ^{[8
]}

Bhorade, Sangeeta M. ^{[9
]}

Crespo, Maria ^{[10
]}

Demissie, Ejigayehu ^{[1
,2
]}

Sonett, Joshua

Wille, Keith ^{[11
]}

Orens, Jonathan ^{[7
,12
]}

Shah, Ashish S. ^{[13
]}

Weinacker, Ann ^{[14
]}

Arcasoy, Selim ^{[6
]}

Shah, Pali D. ^{[12
]}

Wilkes, David S. ^{[15
]}

Ware, Lorraine B. ^{[16
,17
]}

Palmer, Scott M. ^{[18
]}

Christie, Jason D. ^{[1
,2
,3
]}

机构：

[1] Univ Penn, Perelman Sch Med, Pulm Allergy & Crit Care Div, Philadelphia, PA 19104 USA

[2] Univ Penn, Perelman Sch Med, Ctr Clin Epidemiol & Biostat, Philadelphia, PA 19104 USA

[3] Univ Penn, Perelman Sch Med, Penn Cardiovasc Inst, Philadelphia, PA 19104 USA

[4] Univ Penn, Perelman Sch Med, Div Cardiovasc Surg, Philadelphia, PA 19104 USA

[5] Univ Penn, Perelman Sch Med, Dept Anesthesiol & Crit Care, Philadelphia, PA 19104 USA

[6] Columbia Univ Coll Phys & Surg, Div Pulm Allergy & Crit Care Med, New York, NY 10032 USA

[7] Columbia Univ Coll Phys & Surg, Dept Surg, New York, NY 10032 USA

[8] Univ Michigan, Div Pulm Allergy & Crit Care Med, Ann Arbor, MI 48109 USA

[9] Univ Chicago, Div Pulm & Crit Care Med, Chicago, IL 60637 USA

[10] Univ Pittsburgh, Div Pulm Allergy & Critical Care, Pittsburgh, PA USA

[11] Univ Alabama Birmingham, Div Pulm & Crit Care Med, Birmingham, AL USA

[12] Johns Hopkins Univ Hosp, Dept Med, Div Pulm Allergy & Crit Care Med, Baltimore, MD 21205 USA

[13] Johns Hopkins Univ Hosp, Dept Surg, Baltimore, MD 21205 USA

[14] Stanford Univ, Div Pulm & Crit Care Med, Palo Alto, CA 94304 USA

[15] Indiana Univ Sch Med, Div Pulm Allergy Crit Care & Occupat Med, Indianapolis, IN USA

[16] Vanderbilt Univ, Dept Med, Nashville, TN USA

[17] Vanderbilt Univ, Dept Pathol Microbiol & Immunol, Nashville, TN USA

[18] Duke Univ, Div Pulm Allergy & Crit Care Med, Raleigh, NC USA

来源：

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE | 2013年 / 187卷 / 05期

关键词：

lung transplantation; clinical risk factors; primary graft dysfunction; ISHLT WORKING GROUP; INTERNATIONAL-SOCIETY; ALLOGRAFT DYSFUNCTION; POTENTIAL REFINEMENTS; HEART; OUTCOMES; INJURY; VENTILATION; SURVIVAL; IMPACT;

D O I：

10.1164/rccm.201210-1865OC

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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); F-IO2 during allograft reperfusion (OR, 1.1 per 10% increase in Fro; 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% Cl, 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% Cl, 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% Cl, 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).

引用

页码：527 / 534

页数：8

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