Kurihara Chitaru, Kaiho Taisuke, Thomae Benjamin, Cerier Emily, Lung Kalvin, Avella Patino Diego, Toyoda Takahide, Yan Yuanqing, Budinger G R Scott, Bharat Ankit
Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Thorac Dis. 2024 Aug 31;16(8):5050-5062. doi: 10.21037/jtd-24-100. Epub 2024 Aug 28.
Lung transplantation represents a pivotal intervention for individuals grappling with end-stage lung diseases, and the role of lung transplantation in acute respiratory distress syndrome (ARDS) patients has garnered increased attention especially after the coronavirus disease 2019 (COVID-19) pandemic. Multiple studies have demonstrated a high incidence of primary graft dysfunction (PGD) in patients with ARDS compared to contemporaneous controls undergoing transplantation for chronic end-stage lung diseases although underlying mechanisms or risk factors remain unknown. This retrospective study investigates the contrasting risk factors for PGD grade 3 in patients with ARDS and chronic respiratory failure undergoing lung transplantation.
The study included 293 patients who underwent lung transplantation from January 2018 through June 2023. We performed a multivariate logistic regression analysis using variables from the univariate logistic regression analyses to predict PGD grade 3.
Our findings reveal distinct predictors for PGD grade 3 in the two cohorts. ARDS patients had higher incidence of PGD grade 3 than non-ARDS patients (30.2% 9.6%, P<0.001). Multivariate logistic regression analysis showed ischemic time [odds ratio (OR) =0.60; 95% confidence interval (CI): 0.40-0.90; P=0.01] as predictor of PGD grade 3 for non-ARDS patients, and age (OR =0.72; 95% CI: 0.52-0.99; P=0.048), pre-operative albumin (OR <0.01; 95% CI: <0.01-0.74; P=0.042) for ARDS patients. Interestingly, there was no notable difference in post-transplant survival between the two groups.
This study highlights differing risk profiles for severe PGD in ARDS and non-ARDS lung transplant recipients, underscoring the need for tailored approaches in managing these patients. It paves the way for further research to refine strategies aimed at reducing PGD incidence and enhancing transplant outcomes in these distinct populations.
肺移植是治疗终末期肺部疾病患者的关键干预措施，尤其是在2019冠状病毒病（COVID-19）大流行之后，肺移植在急性呼吸窘迫综合征（ARDS）患者中的作用受到了越来越多的关注。多项研究表明，与接受慢性终末期肺病移植的同期对照组相比，ARDS患者原发性移植功能障碍（PGD）的发生率较高，但其潜在机制或危险因素尚不清楚。这项回顾性研究调查了ARDS患者和慢性呼吸衰竭患者在接受肺移植时发生3级PGD的不同危险因素。
该研究纳入了2018年1月至2023年6月期间接受肺移植的293例患者。我们使用单变量逻辑回归分析中的变量进行多变量逻辑回归分析，以预测3级PGD。
我们的研究结果揭示了两个队列中3级PGD的不同预测因素。ARDS患者3级PGD的发生率高于非ARDS患者（30.2%对9.6%，P<0.001）。多变量逻辑回归分析显示，缺血时间[比值比（OR）=0.60；95%置信区间（CI）：0.40-0.90；P=0.01]是非ARDS患者3级PGD的预测因素，而年龄（OR =0.72；95%CI：0.52-0.99；P=0.048）、术前白蛋白（OR <0.01；95%CI：<0.01-0.74；P=0.042）是ARDS患者3级PGD的预测因素。有趣的是，两组患者移植后的生存率没有显著差异。
本研究强调了ARDS和非ARDS肺移植受者发生严重PGD的不同风险特征，强调了对这些患者进行个性化管理的必要性。它为进一步研究改进策略以降低这些不同人群中PGD的发生率和提高移植结局铺平了道路。
