Lung size mismatch and primary graft dysfunction after bilateral lung transplantation

被引:100
作者
Eberlein, Michael [1 ]
Reed, Robert M. [2 ]
Bolukbas, Servet [3 ]
Diamond, Joshua M. [6 ]
Wille, Keith M. [4 ]
Orens, Jonathan B. [5 ]
Brower, Roy G. [5 ]
Christie, Jason D. [6 ]
机构
[1] Univ Iowa, Hosp & Clin, Div Pulm Crit Care & Occupat Med, Iowa City, IA 52242 USA
[2] Univ Maryland, Sch Med, Div Pulm & Crit Care Med, Baltimore, MD 21201 USA
[3] Dr Horst Schmidt Klin, Dept Thorac Surg, Wiesbaden, Germany
[4] Univ Alabama Birmingham, Div Pulm Allergy & Crit Care Med, Birmingham, AL USA
[5] Johns Hopkins Univ, Div Pulm & Crit Care Med, Baltimore, MD USA
[6] Univ Penn, Perelman Sch Med, Div Pulm & Crit Care Med, Philadelphia, PA 19104 USA
基金
美国国家卫生研究院;
关键词
lung transplantation; lung size mismatch; primary graft dysfunction; mechanical ventilation; tidal volume; DELAYED CHEST CLOSURE; MECHANICAL VENTILATION; SURVIVAL; ALLOCATION; DONOR; RECIPIENT; ALLOGRAFT; PRESSURE; OUTCOMES; VOLUMES;
D O I
10.1016/j.healun.2014.09.030
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Donor-to-recipient lung size matching at lung transplantation (LTx) can be estimated by the predicted total lung capacity (pTLC) ratio (dondr pTLC/recipient pTLC). We aimed to determine whether the pTLC ratio is associated with the risk of primary graft dysfunction (PGD) after bilateral LTx (BLT). METHODS: We calculated the pTLC ratio for 812 adult BLTs from the Lung Transplant Outcomes Group between March 2002 to December 2010. Patients were stratified by pTLC ratio > 1.0 ("oversized") and pTLC ratio 1.0 ("undersized"). PGD was defined as any ISHLT Grade 3 PGD (PGD3) within 72 hours of reperfusion. We analyzed the association between risk factors and PGD using multivariable conditional logistic regression. As transplant diagnoses can influence the size-matching decisions and also modulate the risk for POD, we performed pre-specified analyses by assessing the impact of lung size mismatch within diagnostic categories. RESULTS: In univariate analyses oversizing was associated with a 39% lower odds of PGD3 (OR 0.61, 95% CI, 0.45-0.85, p = 0.003). In a multivariate model accounting for center-effects and known PGD risks, oversizing remained independently associated with a decreased odds of PGD3 (OR 0.58, 95% CI 0.38 to 0.88, p = 0.01). The risk-adjusted point estimate was similar for the non-COPD diagnosis groups (OR 0.52, 95% CI 0.32 to 0.86, p = 0.01); however, there was no detected association within the COPD group (OR 0.72, 95% CI 0.29 to 1.78, p = 0.5). CONCLUSION: Oversized allografts are associated with a decreased risk of PGD3 after BLT; this effect appears most apparent in non-COPD patients. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.
引用
收藏
页码:233 / 240
页数:8
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