Elevated Pulmonary Artery Pressure Is a Risk Factor for Primary Graft Dysfunction Following Lung Transplantation for Idiopathic Pulmonary Fibrosis

Fang, Adam; Studer, Sean M.; Kawut, Steven M.; Ahya, Vivek N.; Lee, James; Wille, Keith; Lama, Vibha N.; Ware, Lorraine B.; Orens, Jonathan B.; Weinacker, Ann; Palmer, Scott M.; Crespo, Maria; Lederer, David J.; Deutschman, Clifford S.; Kohl, Benjamin; Bellamy, Scarlett L.; Demissie, Ejigayehu; Christie, Jason D.

doi:10.1378/chest.09-2806

Cited by 94 publications

(78 citation statements)

References 29 publications

(39 reference statements)

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“…We compared variables using the Mann-Whitney or Chi-square test. Potential risk factors for grade 3 PGD previously identified in the literature and shown by univariate analysis in our study or with hypothetical clinical or biologic plausibility were selected for analysis (1)(2)(3)(4)(5)(6)(7)(8)(10)(11)(12)(13)(14)(15)(16)(17)(18). A logistic regression model was used to identify the independent variables associated with grade 3 PGD.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and outcome of primary graft dysfunction after lung transplantation in Korea

Moon

Park

Lee³

et al. 2016

J. Thorac. Dis.

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Background: Primary graft dysfunction (PGD) is a severe, acute and post-transplantation lung injury associated with early morbidity and mortality. We aimed to identify clinical risk factors for PGD, as well as the outcome of PGD after lung transplantation in Korea.Methods: We retrospectively analyzed lung transplant patients in a South Korean Hospital. The primary outcome was grade 3 PGD, defined according to the International Society for Heart and Lung Transplantation criteria. We compared grade 0-2 PGD group to grade 3 PGD group to identify the risk factors and outcome of grade 3 PGD.Results: Sixty-one patients were enrolled; 16 (26.2%) developed grade 3 PGD. Univariate analysis revealed higher body mass index (BMI) and history of smoking, extracorporeal membrane oxygenation (ECMO) before transplantation in recipients, and an extended intraoperative ischemic time as risk factors for grade 3 PGD. In multivariate analysis, independent risk factors for PGD were higher BMI in recipients [odds ratio (OR), 1.286; P=0.043] and total intraoperative ischemic time (OR, 1.028; P=0.007). As compared to grade 0-2 PGD, grade 3 PGD was significantly associated with a higher re-operation rate (grade 0-2 PGD vs. grade 3 PGD, 22.2% vs. 50.0%; P=0.036), prolonged ventilator apply (median: 6.0 vs. 14.5 days; P=0.044), a longer intensive care unit stay (median: 9.0 vs. 17.0 days; P=0.041), and a higher rate of renal replacement therapy (RRT) (17.8% vs. 62.5%; P=0.002) after transplantation. Conclusions:Patients who developed grade 3 PGD had higher re-operation rate, longer ventilator apply, longer intensive care unit stay, higher rate of RRT, with higher BMI and total intraoperative ischemic time being the significant risk factor. These findings may allow physicians to modify risk factors before development of PGD.

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Section: Discussionmentioning

confidence: 99%

Risk factors and outcome of primary graft dysfunction after lung transplantation in Korea

Moon

Park

Lee³

et al. 2016

J. Thorac. Dis.

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“…LTOG is an NHLBI-funded prospective cohort study of lung transplant recipients with the primary aim of examining clinical and genetic risk factors for PGD at nine United States centers (a full list of investigators and participating centers appears before the REFERENCES section) (22)(23)(24)(25)(26)(27)(28). Based on a reported association between obesity and early mortality after lung transplantation for COPD and ILD (21), we restricted our study sample to 512 adult LTOG participants with COPD or ILD who underwent single or bilateral lung transplantation between March 2002 and July 2009 and who had complete exposure and outcome data.…”

Section: Methods Study Design and Participantsmentioning

confidence: 99%

Obesity and Primary Graft Dysfunction after Lung Transplantation

Lederer¹,

Kawut

Wickersham

et al. 2011

Am J Respir Crit Care Med

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143

102

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Rationale: Obesity has been linked to acute lung injury and is a risk factor for early mortality after lung transplantation. Objectives: To examine the associations of obesity and plasma adipokines with the risk of primary graft dysfunction after lung transplantation. Methods: We performed a prospective cohort study of 512 adult lung transplant recipients with chronic obstructive pulmonary disease or interstitial lung disease enrolled in the Lung Transplant Outcomes Group Study. In a nested case-control study, we measured plasma leptin, adiponectin, and resistin before lung transplantation and 6 and 24 hours after lung transplantation in 40 cases of primary graft dysfunction and 80 control subjects. Generalized linear mixed models and logistic regression were used to estimate risk ratios and odds ratios. Measurements and Main Results: Grade 3 primary graft dysfunction developed within 72 hours of transplantation in 29% participants. Obesity was associated with a twofold increased risk of primary graft dysfunction (adjusted risk ratio 2.1; 95% confidence interval, 1.7-2.6). The risk of primary graft dysfunction increased by 40% (confidence interval, 30-50%) for each 5 kg/m 2 increase in body mass index after accounting for center, diagnosis, cardiopulmonary bypass, and transplant procedure. Higher plasma leptin levels were associated with a greater risk of primary graft dysfunction (sexadjusted P ¼ 0.02). The associations of both obesity and leptin with primary graft dysfunction tended to be stronger among those who did not undergo cardiopulmonary bypass. Conclusions: Obesity is an independent risk factor for primary graft dysfunction after lung transplantation.

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“…[9][10][11][12][13][14][15] Subjects were enrolled from 10 US transplant centers from March 2002 through December 2010. Patients undergoing lung or combined heart-lung transplantation at a participating center were eligible for inclusion in the Lung Transplant Outcomes Group study if their age at the time of transplantation was between 18 and 80 years and they provided informed consent.…”

Section: Study Populationmentioning

confidence: 99%

Latent Class Analysis Identifies Distinct Phenotypes of Primary Graft Dysfunction After Lung Transplantation

Shah

Diamond

Cantu

et al. 2013

Chest

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Elevated Pulmonary Artery Pressure Is a Risk Factor for Primary Graft Dysfunction Following Lung Transplantation for Idiopathic Pulmonary Fibrosis

Cited by 94 publications

References 29 publications

Risk factors and outcome of primary graft dysfunction after lung transplantation in Korea

Risk factors and outcome of primary graft dysfunction after lung transplantation in Korea

Obesity and Primary Graft Dysfunction after Lung Transplantation

Latent Class Analysis Identifies Distinct Phenotypes of Primary Graft Dysfunction After Lung Transplantation

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