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Quantitative Evidence for Revising the Definition of Primary Graft Dysfunction after Lung Transplant.

Publication ,  Journal Article
Cantu, E; Diamond, JM; Suzuki, Y; Lasky, J; Schaufler, C; Lim, B; Shah, R; Porteous, M; Lederer, DJ; Kawut, SM; Palmer, SM; Snyder, LD ...
Published in: Am J Respir Crit Care Med
January 15, 2018

RATIONALE: Primary graft dysfunction (PGD) is a form of acute lung injury that occurs after lung transplantation. The definition of PGD was standardized in 2005. Since that time, clinical practice has evolved, and this definition is increasingly used as a primary endpoint for clinical trials; therefore, validation is warranted. OBJECTIVES: We sought to determine whether refinements to the 2005 consensus definition could further improve construct validity. METHODS: Data from the Lung Transplant Outcomes Group multicenter cohort were used to compare variations on the PGD definition, including alternate oxygenation thresholds, inclusion of additional severity groups, and effects of procedure type and mechanical ventilation. Convergent and divergent validity were compared for mortality prediction and concurrent lung injury biomarker discrimination. MEASUREMENTS AND MAIN RESULTS: A total of 1,179 subjects from 10 centers were enrolled from 2007 to 2012. Median length of follow-up was 4 years (interquartile range = 2.4-5.9). No mortality differences were noted between no PGD (grade 0) and mild PGD (grade 1). Significantly better mortality discrimination was evident for all definitions using later time points (48, 72, or 48-72 hours; P < 0.001). Biomarker divergent discrimination was superior when collapsing grades 0 and 1. Additional severity grades, use of mechanical ventilation, and transplant procedure type had minimal or no effect on mortality or biomarker discrimination. CONCLUSIONS: The PGD consensus definition can be simplified by combining lower PGD grades. Construct validity of grading was present regardless of transplant procedure type or use of mechanical ventilation. Additional severity categories had minimal impact on mortality or biomarker discrimination.

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Published In

Am J Respir Crit Care Med

DOI

EISSN

1535-4970

Publication Date

January 15, 2018

Volume

197

Issue

2

Start / End Page

235 / 243

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Time Factors
  • Survival Rate
  • Severity of Illness Index
  • Risk Assessment
  • Retrospective Studies
  • Respiratory System
  • Reproducibility of Results
  • Proportional Hazards Models
 

Citation

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Cantu, E., Diamond, J. M., Suzuki, Y., Lasky, J., Schaufler, C., Lim, B., … Lung Transplant Outcomes Group, . (2018). Quantitative Evidence for Revising the Definition of Primary Graft Dysfunction after Lung Transplant. Am J Respir Crit Care Med, 197(2), 235–243. https://doi.org/10.1164/rccm.201706-1140OC
Cantu, Edward, Joshua M. Diamond, Yoshikazu Suzuki, Jared Lasky, Christian Schaufler, Brian Lim, Rupal Shah, et al. “Quantitative Evidence for Revising the Definition of Primary Graft Dysfunction after Lung Transplant.Am J Respir Crit Care Med 197, no. 2 (January 15, 2018): 235–43. https://doi.org/10.1164/rccm.201706-1140OC.
Cantu E, Diamond JM, Suzuki Y, Lasky J, Schaufler C, Lim B, et al. Quantitative Evidence for Revising the Definition of Primary Graft Dysfunction after Lung Transplant. Am J Respir Crit Care Med. 2018 Jan 15;197(2):235–43.
Cantu, Edward, et al. “Quantitative Evidence for Revising the Definition of Primary Graft Dysfunction after Lung Transplant.Am J Respir Crit Care Med, vol. 197, no. 2, Jan. 2018, pp. 235–43. Pubmed, doi:10.1164/rccm.201706-1140OC.
Cantu E, Diamond JM, Suzuki Y, Lasky J, Schaufler C, Lim B, Shah R, Porteous M, Lederer DJ, Kawut SM, Palmer SM, Snyder LD, Hartwig MG, Lama VN, Bhorade S, Bermudez C, Crespo M, McDyer J, Wille K, Orens J, Shah PD, Weinacker A, Weill D, Wilkes D, Roe D, Hage C, Ware LB, Bellamy SL, Christie JD, Lung Transplant Outcomes Group. Quantitative Evidence for Revising the Definition of Primary Graft Dysfunction after Lung Transplant. Am J Respir Crit Care Med. 2018 Jan 15;197(2):235–243.

Published In

Am J Respir Crit Care Med

DOI

EISSN

1535-4970

Publication Date

January 15, 2018

Volume

197

Issue

2

Start / End Page

235 / 243

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Time Factors
  • Survival Rate
  • Severity of Illness Index
  • Risk Assessment
  • Retrospective Studies
  • Respiratory System
  • Reproducibility of Results
  • Proportional Hazards Models