Lung transplant for interstitial lung disease: outcomes for single versus bilateral lung transplantation

Oliveira, Nilto C. De; Osaki, Satoru; Maloney, James D.; Cornwell, Richard; Meyer, Keith C.

doi:10.1093/icvts/ivr085

Cited by 49 publications

(43 citation statements)

References 16 publications

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“…The primary definition of grade 3 PGD at 48 or 72 hours after transplant was associated with a relative risk (RR) of 4.8 (95% CI, 3.3-7.0; P , 0.001) for death within 90 days of transplant compared with those without grade 3 PGD and an ARI of 18% (95% CI, 12-24). Grade 3 PGD was associated with a significantly increased 1-year mortality (RR, 3.0; 95% CI, 2.3-3.9; P , 0.001) compared with those without grade 3 PGD, and an ARI of 23% (95% CI, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Although the magnitude of the association between grade 3 PGD and mortality was attenuated when the alternate definition of any grade 3 PGD within 72 hours was used in the sensitivity analyses, the association remained significant at 90 days (RR, 3.5; 95% CI, 2.3-5.1; P , 0.001) and 1 year (RR, 2.5; 95% CI, 1.9-3.3; P , 0.001) (see Table E6).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

Diamond¹,

Lee²,

Kawut³

et al. 2013

The Journal of Heart and Lung Transplantation

154

294

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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 posttransplant. 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 ¼ 0.002); FI O 2 during allograft reperfusion (OR, 1.1 per 10% increase in FI O 2 ; 95% CI, 1.0-1.2; P ¼ 0.01); single lung transplant (OR, 2; 95% CI, 1.2-3.3; P ¼ 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 ¼ 0.01) and obese (OR, 2.3; 95% CI, 1.3-3.9; P ¼ 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1-5.6; P ¼ 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6-7.7; P ¼ 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). What This Study Adds to the FieldWe performed a multicenter, prospective cohort study of 1,255 lung transplant recipients across 10 US transplant centers. We identified receipt of an organ from a donor with any smoking history, elevated FI O 2 during allograft reperfusion, preoperative sarcoidosis or pulmonary arterial hypertension, use of cardiopulmonary bypass, single lung transplant, large-volume blood product transfusion, elevated pulmonary arterial pressures, and overweight or obese recipient body habitus as risk factors for grade 3 PGD. Several of these risk factors are potentially modifiable, and thus may suggest preventative strategies, whereas other risk factors should be prioritized for future mechanistic research efforts.

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Section: Resultsmentioning

confidence: 99%

“…Potential risk factors for grade 3 PGD previously identified in the literature or with hypothetical clinical or biologic plausibility were selected for analysis a priori (5)(6)(7)(14)(15)(16)(17)(18)(19)(20). Details of covariate definitions are included in the online supplement.…”

Section: Candidate Risk Factor Selection and Definitionmentioning

confidence: 99%

Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

Diamond¹,

Lee²,

Kawut³

et al. 2013

The Journal of Heart and Lung Transplantation

154

294

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“…8,11 Another previous study showed that outcomes in patients who had interstitial lung disease were comparable or better with single than bilateral lung transplant, and short-and long-term survival were not significantly different for the 2 types of procedures. 15 The findings based on United Network for Organ Sharing data showed that bilateral lung transplant had significantly better survival than single lung transplant. 3 The present study did not confirm a significant effect of type of transplant on survival that was previously reported.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Hosseini-Baharanchi

Hajizadeh²,

Najafizadeh³

et al. 2014

Exp Clin Transplant

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Results: There were 54 male recipients (78%), and the most frequent indications for transplant included pulmonary fibrosis in 31 patients (45%) and bronchiectasis in 23 patients (33%). Recipient mean age was 36 ± 13 years and body mass index was 20 ± 4 kg/m 2 . Mean half-life (all recipients) was 2 ± 1 years and survival was 73% at 1 month, 67% at 1 year, and 40% at 5 years after transplant. For recipients who survived > 2 weeks after transplant half-life and survival were similar to previously international reported results. Recipient age, sex, type of transplant, body mass index, and pulmonary artery pressure were not associated with survival. Survival was significantly higher with recipient bronchiectasis, younger donors, and female donors. Conclusions: Survival after lung transplant was better with recipients who had bronchiectasis and donors that were younger or female. Patient selection, invasive monitoring, and supportive techniques such as extracorporeal membrane oxygenation for unstable patients during surgery may be helpful.

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“…Additionally, we have observed that following the implementation of the LAS at our institution, patients with the transplant indication of IPF were significantly older, had increased supplemental oxygen requirements, a lower cardiac index, and more comorbidities [26]. However, despite the increased disease severity and strong association of significant Group 3 PH with IPF, long-term recipient outcomes have not been significantly compromised for our patients with a pre-transplant diagnosis of pulmonary fibrosis [27].…”

Section: Discussionmentioning

confidence: 80%

Single lung transplantation has equivalent long term outcomes to bilateral lung transplantation in patients with pulmonary hypertension associated with advanced lung disease

Julliard¹,

Meyer²,

Oliveira³

et al. 2016

Trends in Transplant

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Whether bilateral lung transplantation (BLT) rather than single lung transplantation (SLT) should be preferentially performed for patients with World Health Association (WHO) Group 3 pulmonary hypertension (PH) associated with advanced lung disease has been controversial. We retrospectively examined the outcomes of 474 consecutive patients who underwent BLT or SLT at our center between 1999 and 2013. After exclusion of patients with cystic fibrosis or those undergoing retransplantation, 179 patients with PH were split into four groups based on their pulmonary artery pressure values (mild versus severe) and transplant type (BLT versus SLT). The incidence of grade 2-3 primary graft dysfunction and mechanical ventilation >48 hours was significantly higher for the BLT versus the SLT recipients. However, long-term survival via the Kaplan-Meier method and appropriate log rank tests did not differ significantly among the four cohorts. Because long-term outcomes for patients who undergo SLT for advanced lung disease associated with WHO Group 3 PH did not differ significantly from those for BLT recipients, even if PH was severe, we suggest that SLT can be performed safely in patients with Group 3 PH associated with ALD and potentially allows improved donor organ utilization.

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Lung transplant for interstitial lung disease: outcomes for single versus bilateral lung transplantation

Cited by 49 publications

References 16 publications

Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

Untitled

Single lung transplantation has equivalent long term outcomes to bilateral lung transplantation in patients with pulmonary hypertension associated with advanced lung disease

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