HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Bryan A. Whitson Dilip S. Nath Cynthia S. Herrington Peter S. Dahlberg Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Whitson, B. A. Articles by Dahlberg, P. S. Search for Related Content PubMed PubMed Citation Articles by Whitson, B. A. Articles by Dahlberg, P. S. Related Collections Lung - transplantation

J Thorac Cardiovasc Surg 2006;131:73-80
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Risk factors for primary graft dysfunction after lung transplantation

University of Minnesota, Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Minneapolis, Minn.

Read at the Eighty-fifth Annual Meeting of The American Association for Thoracic Surgery, San Francisco, Calif, April 10-13, 2005.

Received for publication June 14, 2005; revisions received October 12, 2005; accepted for publication October 25, 2005.

^_* Address for reprints: Peter S. Dahlberg, MD, PhD, University of Minnesota, MMC 207, 420 Delaware St SE, Minneapolis, MN 55455. (Email: dahlb002{at}umn.edu).

OBJECTIVE: The International Society for Heart and Lung Transplantation has proposed a new grading system for primary graft dysfunction based on the ratio of arterial oxygen to fraction of inspired oxygen measured within 48 hours after lung transplantation. Worsening primary graft dysfunction grade is associated with increased operative mortality rates and decreased long-term survival. This study evaluated donor and recipient risk factors for postoperative International Society for Heart and Lung Transplantation grade 3 primary graft dysfunction.

METHODS: We reviewed donor and recipient medical records of 402 consecutive lung transplantations performed between 1992 and 2004. We calculated a worst International Society for Heart and Lung Transplantation primary graft dysfunction grade in the first 48 hours postoperatively. Severe primary graft dysfunction (International Society for Heart and Lung Transplantation grade 3) was defined by a ratio of arterial oxygen to fraction of inspired oxygen of less than 200. Associations of potential risk factors with grade 3 primary graft dysfunction in the first 48 hours postoperatively were examined through bivariate and multivariate analysis.

RESULTS: The 90-day mortality rate associated with the development of International Society for Heart and Lung Transplantation grade 3 primary graft dysfunction in the first 48 hours postoperatively was 17% versus 9% in the group without grade 3 primary graft dysfunction. Significant bivariate risk factors associated with this end point were increasing donor age, donor smoking history of more than 10 pack-years, early transplantation era (1992-1998), increasing preoperative recipient pulmonary artery pressure, and recipient diagnosis. In the multivariate analysis only recipient pulmonary artery pressure, donor age, and transplantation era were associated with grade 3 primary graft dysfunction in the first 48 hours postoperatively at a P value of less than .05.

CONCLUSIONS: Our analysis of donor and recipient risk factors for severe primary graft dysfunction identified patient groups at high risk for poor outcomes after lung transplantation that might benefit from treatments aimed at reducing reperfusion injury.

This article has been cited by other articles:

				T. Iwata, A. Philipovskiy, A. J. Fisher, R. G. Presson Jr., M. Chiyo, J. Lee, E. Mickler, G. N. Smith, I. Petrache, D. B. Brand, et al. Anti-Type V Collagen Humoral Immunity in Lung Transplant Primary Graft Dysfunction J. Immunol., October 15, 2008; 181(8): 5738 - 5747. [Abstract] [Full Text] [PDF]

				J. L. Bobadilla, R. B. Love, E. Jankowska-Gan, Q. Xu, L. D. Haynes, R. K. Braun, M. S. Hayney, A. Munoz del Rio, K. Meyer, D. S. Greenspan, et al. Th-17, Monokines, Collagen Type V, and Primary Graft Dysfunction in Lung Transplantation Am. J. Respir. Crit. Care Med., March 15, 2008; 177(6): 660 - 668. [Abstract] [Full Text] [PDF]

				L. M. Gazoni, V. E. Laubach, D. P. Mulloy, A. Bellizzi, E. B. Unger, J. Linden, P. I. Ellman, T. C. Lisle, and I. L. Kron Additive protection against lung ischemia-reperfusion injury by adenosine A2A receptor activation before procurement and during reperfusion J. Thorac. Cardiovasc. Surg., January 1, 2008; 135(1): 156 - 165. [Abstract] [Full Text] [PDF]

				M. E. Prekker, C. S. Herrington, M. I. Hertz, D. M. Radosevich, and P. S. Dahlberg Early Trends in PaO2/Fraction of Inspired Oxygen Ratio Predict Outcome in Lung Transplant Recipients With Severe Primary Graft Dysfunction Chest, September 1, 2007; 132(3): 991 - 997. [Abstract] [Full Text] [PDF]

				L. M. Gazoni, C. G. Tribble, M. Q. Zhao, E. B. Unger, R. A. Farrar, P. I. Ellman, L. G. Fernandez, V. E. Laubach, and I. L. Kron Pulmonary Macrophage Inhibition and Inhaled Nitric Oxide Attenuate Lung Ischemia-Reperfusion Injury Ann. Thorac. Surg., July 1, 2007; 84(1): 247 - 253. [Abstract] [Full Text] [PDF]

				P. A. Corris and J. D. Christie Update in Transplantation 2006 Am. J. Respir. Crit. Care Med., March 1, 2007; 175(5): 432 - 435. [Full Text] [PDF]