Moon Sungwoo, Park Moo Suk, Lee Jin Gu, Jung Ji Ye, Kang Young Ae, Kim Young Sam, Kim Se Kyu, Chang Joon, Paik Hyo Chae, Kim Song Yee
Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea.
J Thorac Dis. 2016 Nov;8(11):3275-3282. doi: 10.21037/jtd.2016.11.48.
Primary graft dysfunction (PGD) is a severe, acute and post-transplantation lung injury associated with early morbidity and mortality. We aimed to identify clinical risk factors for PGD, as well as the outcome of PGD after lung transplantation in Korea.
We retrospectively analyzed lung transplant patients in a South Korean Hospital. The primary outcome was grade 3 PGD, defined according to the International Society for Heart and Lung Transplantation criteria. We compared grade 0-2 PGD group to grade 3 PGD group to identify the risk factors and outcome of grade 3 PGD.
Sixty-one patients were enrolled; 16 (26.2%) developed grade 3 PGD. Univariate analysis revealed higher body mass index (BMI) and history of smoking, extracorporeal membrane oxygenation (ECMO) before transplantation in recipients, and an extended intraoperative ischemic time as risk factors for grade 3 PGD. In multivariate analysis, independent risk factors for PGD were higher BMI in recipients [odds ratio (OR), 1.286; P=0.043] and total intraoperative ischemic time (OR, 1.028; P=0.007). As compared to grade 0-2 PGD, grade 3 PGD was significantly associated with a higher re-operation rate (grade 0-2 PGD . grade 3 PGD, 22.2% . 50.0%; P=0.036), prolonged ventilator apply (median: 6.0 . 14.5 days; P=0.044), a longer intensive care unit stay (median: 9.0 . 17.0 days; P=0.041), and a higher rate of renal replacement therapy (RRT) (17.8% . 62.5%; P=0.002) after transplantation.
Patients who developed grade 3 PGD had higher re-operation rate, longer ventilator apply, longer intensive care unit stay, higher rate of RRT, with higher BMI and total intraoperative ischemic time being the significant risk factor. These findings may allow physicians to modify risk factors before development of PGD.
原发性移植肺功能障碍（PGD）是一种严重的急性移植后肺损伤，与早期发病率和死亡率相关。我们旨在确定PGD的临床危险因素以及韩国肺移植后PGD的结局。
我们回顾性分析了韩国一家医院的肺移植患者。主要结局是根据国际心肺移植学会标准定义的3级PGD。我们将0-2级PGD组与3级PGD组进行比较，以确定3级PGD的危险因素和结局。
共纳入61例患者；16例（26.2%）发生3级PGD。单因素分析显示，较高的体重指数（BMI）、吸烟史、受者移植前体外膜肺氧合（ECMO）以及术中缺血时间延长是3级PGD的危险因素。多因素分析显示，PGD的独立危险因素是受者较高的BMI[比值比（OR），1.286；P=0.043]和术中总缺血时间（OR，1.028；P=0.007）。与0-2级PGD相比，3级PGD与更高的再次手术率（0-2级PGD对3级PGD，22.2%对50.0%；P=0.036）、延长的呼吸机使用时间（中位数：6.0对14.5天；P=0.044）、更长的重症监护病房住院时间（中位数：9.0对17.0天；P=0.041）以及移植后更高的肾脏替代治疗（RRT）率（17.8%对62.5%；P=0.002）显著相关。
发生3级PGD的患者再次手术率更高、呼吸机使用时间更长、重症监护病房住院时间更长、RRT率更高，较高的BMI和术中总缺血时间是重要危险因素。这些发现可能使医生在PGD发生前改变危险因素。
