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

Publication ,  Journal Article
Porteous, MK; Lee, JC; Lederer, DJ; Palmer, SM; Cantu, E; Shah, RJ; Bellamy, SL; Lama, VN; Bhorade, SM; Crespo, MM; McDyer, JF; Wille, KM ...
Published in: Ann Am Thorac Soc
October 2017

RATIONALE: Pulmonary hypertension from pulmonary arterial hypertension or parenchymal lung disease is associated with an increased risk for primary graft dysfunction after lung transplantation. OBJECTIVE: We evaluated the clinical determinants of severe primary graft dysfunction in pulmonary hypertension and developed and validated a prognostic model. METHODS: 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 PaO2/FiO2 ≤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. RESULTS: 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. CONCLUSIONS: 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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Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

October 2017

Volume

14

Issue

10

Start / End Page

1514 / 1522

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Tissue Donors
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Prognosis
  • Primary Graft Dysfunction
  • Obesity
  • Middle Aged
 

Citation

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Porteous, M. K., Lee, J. C., Lederer, D. J., Palmer, S. M., Cantu, E., Shah, R. J., … Lung Transplant Outcomes Group, . (2017). Clinical Risk Factors and Prognostic Model for Primary Graft Dysfunction after Lung Transplantation in Patients with Pulmonary Hypertension. Ann Am Thorac Soc, 14(10), 1514–1522. https://doi.org/10.1513/AnnalsATS.201610-810OC
Porteous, Mary K., James C. Lee, David J. Lederer, Scott M. Palmer, Edward Cantu, Rupal J. Shah, Scarlett L. Bellamy, et al. “Clinical Risk Factors and Prognostic Model for Primary Graft Dysfunction after Lung Transplantation in Patients with Pulmonary Hypertension.Ann Am Thorac Soc 14, no. 10 (October 2017): 1514–22. https://doi.org/10.1513/AnnalsATS.201610-810OC.
Porteous MK, Lee JC, Lederer DJ, Palmer SM, Cantu E, Shah RJ, et al. Clinical Risk Factors and Prognostic Model for Primary Graft Dysfunction after Lung Transplantation in Patients with Pulmonary Hypertension. Ann Am Thorac Soc. 2017 Oct;14(10):1514–22.
Porteous, Mary K., et al. “Clinical Risk Factors and Prognostic Model for Primary Graft Dysfunction after Lung Transplantation in Patients with Pulmonary Hypertension.Ann Am Thorac Soc, vol. 14, no. 10, Oct. 2017, pp. 1514–22. Pubmed, doi:10.1513/AnnalsATS.201610-810OC.
Porteous MK, Lee JC, Lederer DJ, Palmer SM, Cantu E, Shah RJ, Bellamy SL, Lama VN, Bhorade SM, Crespo MM, McDyer JF, Wille KM, Localio AR, Orens JB, Shah PD, Weinacker AB, Arcasoy S, Wilkes DS, Ware LB, Christie JD, Kawut SM, Diamond JM, Lung Transplant Outcomes Group. Clinical Risk Factors and Prognostic Model for Primary Graft Dysfunction after Lung Transplantation in Patients with Pulmonary Hypertension. Ann Am Thorac Soc. 2017 Oct;14(10):1514–1522.

Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

October 2017

Volume

14

Issue

10

Start / End Page

1514 / 1522

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Tissue Donors
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Prognosis
  • Primary Graft Dysfunction
  • Obesity
  • Middle Aged