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19. RISK FACTORS FOR PRIMARY GRAFT DYSFUNCTION FOLLOWING LUNG TRANSPLANTATION
Dilip S Nath, Adam C Johnson, Adam R Walker, Matthew E Prekker, Cynthia S Herrington, Peter S Dahlberg; Minneapolis, MN
Objective: The International Society for Heart and Lung Transplantation (ISHLT) has proposed a new grading system for primary graft dysfunction (PGD) that is based on the ratio of arterial oxygen to fraction of inspired oxygen (P/F) measured within 48 hours following lung transplantation. The purpose of this study was to determine how well ISHLT PGD grade predicts surgical mortality rates and to determine risk factors for PGD.
Methods: We reviewed donor and recipient medical records of 374 consecutive lung transplants performed between 1992 and 2003. We calculated ISHLT PGD grades of patients at ICU arrival (T0), 24 hrs (T24), 48hrs (T48), and as a worst grade in the 1st 48 hours T(0-48). Severe PGD (ISHLT grade III) was defined by a P/F ratio of less than 200.
Results: Recipient grade III PGD measured as the composite T(0-48) score was a risk factor for 90-day mortality (19% versus 10% (odds ratio 2.1, 95%CI 1.2-4.0). Univariate risk factors associated with development of T(0-48)grade III PGD are listed in Table 1. Increasing preoperative pulmonary artery pressure, increasing donor age and a recipient diagnosis other than COPD were significant multivariate factors for developing grade III PGD.
Conclusions: Severe ISHLT PGD grade is a surrogate for early death following lung transplantation. Analysis of donor and recipient risk factors identify groups of patients at high risk for severe PGD that may benefit from treatments aimed at reducing reperfusion injury.
T(0-48) grade III PGD incidence based on risk factor
| Risk Factor |
|
T (0-48) grade III PGD |
Univariate p value |
Multivariate p value |
| Preop PA pressure# |
< 25
(n=190) |
28%
(n=54) |
0.01 |
0.03 |
|
> 25
(n=144) |
43%
(n=62) |
|
|
| Donor smoking history* |
< 20 pack years
(n=284) |
34%
(n=97) |
0.04 |
0.94 |
|
> 20 pack years
(n=49) |
49%
(n=24) |
|
|
| Donor age# |
< 45
(n=273) |
32%
(n=90) |
0.01 |
0.01 |
|
> 45
(n=94) |
43%
(n=41) |
|
|
| COPD* |
Yes
(n=232) |
30%
(n=70) |
0.01 |
0.01 |
|
No
(n=146) |
42%
(n=62) |
|
|
analyzed as
# continuous
* ordinal variable |
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