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Clinical Risk Factors and Prognostic Model for Primary Graft Dysfunction after Lung Transplantation in Patients with Pulmonary Hypertension
Journal article   Open access   Peer reviewed

Clinical Risk Factors and Prognostic Model for Primary Graft Dysfunction after Lung Transplantation in Patients with Pulmonary Hypertension

Mary K Porteous, James C Lee, David J Lederer, Scott M Palmer, Edward Cantu, Rupal J Shah, Scarlett L Bellamy, Vibha N Lama, Sangeeta M Bhorade, Maria M Crespo, …
Annals of the American Thoracic Society, v 14(10), pp 1514-1522
Oct 2017
DOI: https://doi.org/10.1513/AnnalsATS.201610-810OC
PMID: 28719755
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1513/annalsats.201610-810ocView
Published, Version of Record (VoR)Open Access (License Unspecified),  Open

Abstract

Adult Body Mass Index Female Humans Hypertension, Pulmonary - complications Linear Models Logistic Models Lung - physiopathology Lung Transplantation - adverse effects Male Middle Aged Obesity - complications Primary Graft Dysfunction - epidemiology Prognosis Retrospective Studies Risk Factors Time Factors Tissue Donors United States Young Adult
Pulmonary hypertension from pulmonary arterial hypertension or parenchymal lung disease is associated with an increased risk for primary graft dysfunction after lung transplantation. We evaluated the clinical determinants of severe primary graft dysfunction in pulmonary hypertension and developed and validated a prognostic model. We conducted a retrospective cohort study of patients in the multicenter Lung Transplant Outcomes Group with pulmonary hypertension at transplant listing. Severe primary graft dysfunction was defined as Pa /Fi ≤200 with allograft infiltrates at 48 or 72 hours after transplantation. Donor, recipient, and operative characteristics were evaluated in a multivariable explanatory model. A prognostic model derived using donor and recipient characteristics was then validated in a separate cohort. In the explanatory model of 826 patients with pulmonary hypertension, donor tobacco smoke exposure, higher recipient body mass index, female sex, listing mean pulmonary artery pressure, right atrial pressure and creatinine at transplant, cardiopulmonary bypass use, transfusion volume, and reperfusion fraction of inspired oxygen were associated with primary graft dysfunction. Donor obesity was associated with a lower risk for primary graft dysfunction. Using a 20% threshold for elevated risk, the prognostic model had good negative predictive value in both derivation and validation cohorts (89.1% [95% confidence interval, 85.3-92.8] and 83.3% [95% confidence interval, 78.5-88.2], respectively), but low positive predictive value. Several recipient, donor, and operative characteristics were associated with severe primary graft dysfunction in patients with pulmonary hypertension, including several risk factors not identified in the overall transplant population. A prognostic model with donor and recipient clinical risk factors alone had low positive predictive value, but high negative predictive value, to rule out high risk for primary graft dysfunction.

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54 citations in Web of Science
59 citations in Scopus

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Collaboration types
Domestic collaboration
Web of Science research areas
Respiratory System
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