Journal article
Lung size mismatch and primary graft dysfunction after bilateral lung transplantation
The Journal of heart and lung transplantation, Vol.34(2), pp.233-240
02/2015
DOI: 10.1016/j.healun.2014.09.030
PMCID: PMC4329253
PMID: 25447586
Abstract
Donor-to-recipient lung size matching at lung transplantation (LTx) can be estimated by the predicted total lung capacity (pTLC) ratio (donor pTLC/recipient pTLC). We aimed to determine whether the pTLC ratio is associated with the risk of primary graft dysfunction (PGD) after bilateral LTx (BLT).
We calculated the pTLC ratio for 812 adult BLTs from the Lung Transplant Outcomes Group between March 2002 to December 2010. Patients were stratified by pTLC ratio >1.0 (“oversized”) and pTLC ratio ≤1.0 (“undersized”). PGD was defined as any ISHLT Grade 3 PGD (PGD3) within 72 hours of reperfusion. We analyzed the association between risk factors and PGD using multivariable conditional logistic regression. As transplant diagnoses can influence the size-matching decisions and also modulate the risk for PGD, we performed pre-specified analyses by assessing the impact of lung size mismatch within diagnostic categories.
In univariate analyses oversizing was associated with a 39% lower odds of PGD3 (OR 0.61, 95% CI, 0.45-0.85, p = 0.003). In a multivariate model accounting for center-effects and known PGD risks, oversizing remained independently associated with a decreased odds of PGD3 (OR 0.58, 95% CI 0.38 to 0.88, p = 0.01). The risk-adjusted point estimate was similar for the non-COPD diagnosis groups (OR 0.52, 95% CI 0.32 to 0.86, p = 0.01); however, there was no detected association within the COPD group (OR 0.72, 95% CI 0.29 to 1.78, p = 0.5).
Oversized allografts are associated with a decreased risk of PGD3 after BLT; this effect appears most apparent in non-COPD patients.
Details
- Title: Subtitle
- Lung size mismatch and primary graft dysfunction after bilateral lung transplantation
- Creators
- Michael Eberlein - Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, Iowa City, IowaRobert M Reed - Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MarylandServet Bolukbas - Department of Thoracic Surgery, Dr. Horst Schmidt Klinik, Wiesbaden, GermanyJoshua M Diamond - Division of Pulmonary and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PennsylvaniaKeith M Wille - Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AlabamaJonathan B Orens - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MarylandRoy G Brower - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MarylandJason D Christie - Division of Pulmonary and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PennsylvaniaLung Transplant Outcomes Group
- Resource Type
- Journal article
- Publication Details
- The Journal of heart and lung transplantation, Vol.34(2), pp.233-240
- DOI
- 10.1016/j.healun.2014.09.030
- PMID
- 25447586
- PMCID
- PMC4329253
- NLM abbreviation
- J Heart Lung Transplant
- ISSN
- 1053-2498
- eISSN
- 1557-3117
- Publisher
- Elsevier BV
- Language
- English
- Date published
- 02/2015
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984094558302771
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