Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
J Heart Lung Transplant. 2019 Jul;38(7):710-718. doi: 10.1016/j.healun.2019.02.010. Epub 2019 Feb 18.
Primary graft dysfunction (PGD) represents ischemia‒reperfusion injury in the lung allograft, and elevated left ventricular end-diastolic pressure (LVEDP) may contribute to capillary leak. We tested whether pre-transplant LVEDP or pulmonary capillary wedge pressure (mPCWP) are related to PGD risk. We hypothesized that elevated LVEDP and mPCWP would increase PGD risk.
We reviewed adult double lung transplant recipients at the University of Alberta Hospital from 2004 to 2016 with pre-transplant LVEDP measurements. The primary outcome was Grade 3 PGD at 48 to 72 hours post-transplant. We used regression analysis to assess the association between LVEDP and mPCWP with Grade 3 PGD risk, as well as agreement between these measurements.
Three hundred thirty double lung transplant recipients were included in the study, and 63 (19%) developed Grade 3 PGD at 48 or 72 hours. Mean LVEDP was 16 ± 7 mm Hg in the Grade 3 PGD group and 12 ± 5 mm Hg in the non-PGD group (p < 0.0001). LVEDP >15 mm Hg was associated with an adjusted odds ratio (OR) of 3.83 (95% confidence interval [CI] 1.90 to 7.73, p < 0.0001), whereas mPCWP >15 mm Hg showed similar findings (adjusted OR 4.25 [1.83 to 9.86], p = 0.0008). Correlation and agreement between LVEDP and mPCWP were fair.
Elevated pre-transplant LVEDP increases the risk of severe PGD after lung transplant, as does elevated mPCWP. These measurements appear to be complementary as markers of prospective PGD risk.
原发性移植物功能障碍（PGD）代表肺移植中的缺血再灌注损伤，而左心室舒张末期压（LVEDP）升高可能导致毛细血管渗漏。我们测试了移植前 LVEDP 或肺毛细血管楔压（mPCWP）是否与 PGD 风险相关。我们假设 LVEDP 和 mPCWP 升高会增加 PGD 风险。
我们回顾了 2004 年至 2016 年在阿尔伯塔大学医院接受双肺移植的成年患者的 LVEDP 测量值。主要结局是移植后 48 至 72 小时的 3 级 PGD。我们使用回归分析评估 LVEDP 和 mPCWP 与 3 级 PGD 风险之间的关系，以及这些测量值之间的一致性。
本研究共纳入 330 例双肺移植患者，其中 63 例（19%）在 48 或 72 小时时发生 3 级 PGD。3 级 PGD 组的 LVEDP 平均值为 16 ± 7mmHg，非 PGD 组为 12 ± 5mmHg（p<0.0001）。LVEDP >15mmHg 与调整后的优势比（OR）为 3.83（95%置信区间 [CI] 1.90 至 7.73，p<0.0001），而 mPCWP >15mmHg 也有类似发现（调整后 OR 4.25 [1.83 至 9.86]，p=0.0008）。LVEDP 和 mPCWP 之间的相关性和一致性为中等。
移植前 LVEDP 升高会增加肺移植后严重 PGD 的风险，mPCWP 升高也是如此。这些测量值似乎可以作为预测 PGD 风险的互补标志物。
