Toyoda Takahide, Cerier Emily Jeong, Manerikar Adwaiy Jayant, Kandula Viswajit, Bharat Ankit, Kurihara Chitaru
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Thorac Dis. 2023 Feb 28;15(2):399-409. doi: 10.21037/jtd-22-974. Epub 2023 Feb 7.
Primary graft dysfunction is a major cause of early mortality following lung transplantation. The International Society for Heart and Lung Transplantation subdivides it into 4 grades of increasing severity.
A retrospective review of the institutional lung transplant database from March 2018 to September 2021 was performed. Patients were stratified into three groups: primary graft dysfunction grade 0 patients, grade 1 or 2 patients, and grade 3 patients. Recipient, donor, and surgical variables were analyzed by logistic regression analysis to identify risk factors for primary graft dysfunction grade 1 or 2 and grade 3.
Primary graft dysfunction grade 1 to 3 occurred in 45.0% of the cohort (n=68) of whom 33.3% (n=23) had primary graft dysfunction grade 3. Longer operative time was more common in primary graft dysfunction grade 1 to 3 patients (P<0.001). The 1-year survival of the patients with primary graft dysfunction grade 3 was lower than the others (grade 0-2 3, 93.7% 65.2%, P=0.0006). Univariate analysis showed that acute respiratory distress syndrome, operative time, and intraoperative veno-arterial extracorporeal membrane oxygenation use were risk factors for primary graft dysfunction grades 1 or 2 and grade 3. Multivariate analysis identified that intraoperative veno-arterial extracorporeal membrane oxygenation use was an independent risk factor of primary graft dysfunction grade 1 or 2. Patients with an operative time of more than 8.18 hours had significantly higher incidence of primary graft dysfunction grade 3, acute kidney injury, and digital ischemia.
The calculated predictors of primary graft dysfunction grade 1 or 2 were similar to those of primary graft dysfunction grade 3.
原发性移植肺功能障碍是肺移植术后早期死亡的主要原因。国际心肺移植学会将其细分为严重程度递增的4个等级。
对2018年3月至2021年9月的机构肺移植数据库进行回顾性分析。患者被分为三组：原发性移植肺功能障碍0级患者、1或2级患者和3级患者。通过逻辑回归分析对受者、供者和手术变量进行分析，以确定原发性移植肺功能障碍1或2级和3级的危险因素。
该队列（n = 68）中45.0%发生了原发性移植肺功能障碍1至3级，其中33.3%（n = 23）为原发性移植肺功能障碍3级。原发性移植肺功能障碍1至3级患者的手术时间更长（P < 0.001）。原发性移植肺功能障碍3级患者的1年生存率低于其他患者（0至2级为93.7%，3级为65.2%，P = 0.0006）。单因素分析显示，急性呼吸窘迫综合征、手术时间和术中静脉-动脉体外膜肺氧合的使用是原发性移植肺功能障碍1或2级和3级的危险因素。多因素分析确定术中静脉-动脉体外膜肺氧合的使用是原发性移植肺功能障碍1或2级的独立危险因素。手术时间超过8.18小时的患者原发性移植肺功能障碍3级、急性肾损伤和手指缺血的发生率显著更高。
计算得出的原发性移植肺功能障碍1或2级的预测因素与原发性移植肺功能障碍3级的相似。
