Risk factors for primary graft dysfunction after lung transplantation
Risk factors for primary graft dysfunction after lung transplantation
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DOI：
10.1016/j.jtcvs.2005.08.039
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发表时间：
2006-01-01
影响因子：
6
通讯作者：
Dahlberg, PS
中科院分区：
文献类型：
--
作者：
Whitson, BA;Nath, DS;Dahlberg, PS
目的：国际心肺移植学会提出了一种新的基于肺移植后48小时内测量的动脉氧与吸入氧分数的比值的原发性移植物功能障碍分级系统。原发性移植物功能障碍分级恶化与手术死亡率增加和长期生存率降低相关。本研究评估了供体和受体术后国际心肺移植学会3级原发性移植物dysfunctions.Methods的危险因素：我们回顾了1992年至2004年进行的402例连续肺移植的供体和受体的病历。我们计算了术后48小时内国际心肺移植学会原发性移植物功能障碍的最差分级。严重的原发性移植物功能障碍（国际心肺移植学会3级）定义为动脉氧与吸入氧的比值小于200。通过双变量和多变量分析，研究了术后48小时内3级原发性移植物功能障碍与潜在危险因素的关系。与术后48小时内发生国际心肺移植学会3级原发性移植物功能障碍相关的90天死亡率分别为17%和9%。无3级原发性移植物功能障碍组。与该终点相关的显著双变量风险因素为供体年龄增加、供体吸烟史超过10包-年、早期移植时代（1992-1998）、术前受体肺动脉压增加和受体诊断。在多变量分析中，只有受体肺动脉压、供体英亩和移植年龄与术后前48小时内3级原发性移植物功能障碍相关，P值小于0.05。我们分析了供者和受者严重原发性移植物功能障碍的危险因素，确定了肺移植后预后不良的高风险患者群体，这些患者可能从治疗中获益。旨在减少再灌注损伤。
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 Intenational 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 acre, 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.