肺移植后原发性移植物功能障碍的临床危险因素。
Clinical risk factors for primary graft dysfunction after lung transplantation.
机构信息
Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
出版信息
Am J Respir Crit Care Med. 2013 Mar 1;187(5):527-34. doi: 10.1164/rccm.201210-1865OC. Epub 2013 Jan 10.
RATIONALE
Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors.
OBJECTIVES
We sought to identify donor, recipient, and perioperative risk factors for PGD.
METHODS
We performed a 10-center prospective cohort study enrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was International Society for Heart and Lung Transplantation grade 3 PGD at 48 or 72 hours post-transplant. The association of potential risk factors with PGD was analyzed using multivariable conditional logistic regression.
MEASUREMENTS AND MAIN RESULTS
A total of 1,255 patients from 10 centers were enrolled; 211 subjects (16.8%) developed grade 3 PGD. In multivariable models, independent risk factors for PGD were any history of donor smoking (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.6; P = 0.002); FiO2 during allograft reperfusion (OR, 1.1 per 10% increase in FiO2; 95% CI, 1.0-1.2; P = 0.01); single lung transplant (OR, 2; 95% CI, 1.2-3.3; P = 0.008); use of cardiopulmonary bypass (OR, 3.4; 95% CI, 2.2-5.3; P < 0.001); overweight (OR, 1.8; 95% CI, 1.2-2.7; P = 0.01) and obese (OR, 2.3; 95% CI, 1.3-3.9; P = 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1-5.6; P = 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6-7.7; P = 0.002); and mean pulmonary artery pressure (OR, 1.3 per 10 mm Hg increase; 95% CI, 1.1-1.5; P < 0.001). PGD was significantly associated with 90-day (relative risk, 4.8; absolute risk increase, 18%; P < 0.001) and 1-year (relative risk, 3; absolute risk increase, 23%; P < 0.001) mortality.
CONCLUSIONS
We identified grade 3 PGD risk factors, several of which are potentially modifiable and should be prioritized for future research aimed at preventative strategies. Clinical trial registered with www.clinicaltrials.gov (NCT 00552357).
背景
原发性移植物功能障碍（PGD）是肺移植后早期发病率和死亡率的主要原因。先前的研究对于 PGD 风险因素的研究结果存在冲突。
目的
我们旨在确定供体、受体和围手术期 PGD 的风险因素。
方法
我们进行了一项 10 中心前瞻性队列研究，纳入时间为 2002 年 3 月至 2010 年 12 月（肺移植结局组）。主要结局为移植后 48 或 72 小时国际心肺移植协会 3 级 PGD。使用多变量条件逻辑回归分析潜在风险因素与 PGD 的关系。
测量和主要结果
共纳入来自 10 个中心的 1255 例患者，其中 211 例（16.8%）发生 3 级 PGD。在多变量模型中，PGD 的独立危险因素包括供体有吸烟史（比值比[OR]，1.8；95%置信区间[CI]，1.2-2.6；P = 0.002）；移植肺再灌注时的 FiO2（OR，FiO2 每增加 10%，1.1；95%CI，1.0-1.2；P = 0.01）；单肺移植（OR，2；95%CI，1.2-3.3；P = 0.008）；使用体外循环（OR，3.4；95%CI，2.2-5.3；P < 0.001）；超重（OR，1.8；95%CI，1.2-2.7；P = 0.01）和肥胖（OR，2.3；95%CI，1.3-3.9；P = 0.004）受体体重指数；术前结节病（OR，2.5；95%CI，1.1-5.6；P = 0.03）或肺动脉高压（OR，3.5；95%CI，1.6-7.7；P = 0.002）；平均肺动脉压（OR，每增加 10mmHg，1.3；95%CI，1.1-1.5；P < 0.001）。PGD 与 90 天（相对风险，4.8；绝对风险增加，18%；P < 0.001）和 1 年（相对风险，3；绝对风险增加，23%；P < 0.001）死亡率显著相关。
结论
我们确定了 3 级 PGD 的风险因素，其中一些是潜在可改变的，应优先考虑未来旨在预防策略的研究。该临床试验已在 www.clinicaltrials.gov 注册（NCT 00552357）。
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