The effect of primary graft dysfunction on survival after lung transplantation
The effect of primary graft dysfunction on survival after lung transplantation
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DOI：
10.1164/rccm.200409-1243oc
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发表时间：
2005-06-01
影响因子：
24.7
通讯作者：
Kimmel, SE
中科院分区：
文献类型：
--
作者：
Christie, JD;Kotloff, RM;Kimmel, SE
原理：原发性移植物功能障碍是肺移植后严重的急性肺损伤综合征。尚未研究原发性移植物功能障碍受试者的长期结局。目标：我们试图使用大型登记研究来测试原发性移植物功能障碍与短期和长期死亡率的关系。研究方法：我们使用了1994年至2000年期间在器官共享联合网络/国际心肺移植登记处收集的5，262例患者的数据。我们评估了所有受试者的结局;为了评估早期死亡影响的潜在偏倚，我们还使用具有时变协变量的考克斯比例风险模型评估了存活至少1年的受试者。主要结果：原发性移植物功能障碍的总体发生率为10.2%（95%置信区间[CI]，9.2，10.9）。在观察期间，发病率没有随年份变化（p = 0.22）。30天时，原发性移植物功能障碍患者的全因死亡率为42.1%，而无移植物功能障碍患者的全因死亡率为6.1%（相对危险度= 6.95; 95%CI，5.98，8.08; p <0.001）;在30天前死亡的受试者中，43.6%患有原发性移植物功能障碍。在存活至少1年的患者中，原发性移植物功能障碍的患者在随后的几年中生存率明显更差（风险比，1.35; 95%CI，1.07，1.70; p = 0.011）。对包括闭塞性细支气管炎综合征在内的临床变量进行调整后，这种关系没有改变。结论：肺移植术后近一半的短期死亡率是由原发性移植物功能障碍引起的。原发性移植物功能障碍的幸存者在移植后第一年死亡的风险增加。
Rationale: Primary graft dysfunction is a severe acute lung injury syndrome after lung transplantation. Long-term outcomes of subjects with primary graft dysfunction have not been studied. Objectives: We sought to test the relationship of primary graft dysfunction with both short- and long-term mortality using a large registry. Methods: We used data collected on 5,262 patients in the United Network for Organ Sharing/international Society of Heart and Lung Transplantation registry between 1994 and 2000. We assessed outcomes in all subjects; to assess potential bias from the effects of early mortality, we also evaluated subjects who survived at least 1 year, using Cox proportional hazards models with time-varying covariates. Main Results: The overall incidence of primary graft dysfunction was 10.2% (95% confidence intervals [CI], 9.2, 10.9). The incidence did not vary by year over the period of observation (p = 0.22). All-cause mortality at 30 days was 42.1% for primary graft dysfunction versus 6.1% in patients without graft dysfunction (relative risk = 6.95; 95% CI, 5.98, 8.08; p < 0.001); among subjects who died by 30 days, 43.6% had primary graft dysfunction. Among patients surviving at least 1 year, those who had primary graft dysfunction had significantly worse survival over ensuing years (hazard ratio, 1.35; 95% CI, 1.07, 1.70; p = 0.011). Adjustment for clinical variables including bronchiolitis obliterans syndrome did not change this relationship. Conclusion: Primary graft dysfunction contributes to nearly half of the short-term mortality after lung transplantation. Survivors of primary graft dysfunction have increased risk of death extending beyond the first post-transplant year.