Objective Estimates Improve Risk Stratification for Primary Graft Dysfunction after Lung Transplantation |
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| Authors: | J. Flesch J. C. Lee D. J. Lederer V. N. Lama J. Orens A. Weinacker D. S. Wilkes D. Roe S. Bhorade K. M. Wille L. B. Ware S. M. Palmer M. Crespo E. Demissie J. Sonnet A. Shah S. M. Kawut S. L. Bellamy A. R. Localio J. D. Christie |
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| Affiliation: | 1. Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA;2. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA;3. Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY;4. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Michigan, Ann Arbor, MI;5. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Johns Hopkins University Hospital, Baltimore, MD;6. Department of Pulmonary and Critical Care, Stanford University, Palo Alto, CA;7. Division of Pulmonary, and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, IN;8. Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL;9. Division of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL;10. Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN;11. Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, NC;12. Division of Pulmonary, Allergy, and Critical Care, University of Pittsburgh, Pittsburgh, PA;13. Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY;14. Department of Surgery, Johns Hopkins University Hospital, Baltimore, MD |
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| Abstract: | Primary graft dysfunction (PGD) is a major cause of early mortality after lung transplant. We aimed to define objective estimates of PGD risk based on readily available clinical variables, using a prospective study of 11 centers in the Lung Transplant Outcomes Group (LTOG). Derivation included 1255 subjects from 2002 to 2010; with separate validation in 382 subjects accrued from 2011 to 2012. We used logistic regression to identify predictors of grade 3 PGD at 48/72 h, and decision curve methods to assess impact on clinical decisions. 211/1255 subjects in the derivation and 56/382 subjects in the validation developed PGD. We developed three prediction models, where low‐risk recipients had a normal BMI (18.5–25 kg/m2), chronic obstructive pulmonary disease/cystic fibrosis, and absent or mild pulmonary hypertension (mPAP<40 mmHg). All others were considered higher‐risk. Low‐risk recipients had a predicted PGD risk of 4–7%, and high‐risk a predicted PGD risk of 15–18%. Adding a donor‐smoking lung to a higher‐risk recipient significantly increased PGD risk, although risk did not change in low‐risk recipients. Validation demonstrated that probability estimates were generally accurate and that models worked best at baseline PGD incidences between 5% and 25%. We conclude that valid estimates of PGD risk can be produced using readily available clinical variables. |
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| Keywords: | clinical research / practice lung transplantation / pulmonology lung (allograft) function / dysfunction lung failure / injury |
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