Objective Estimates Improve Risk Stratification for Primary Graft Dysfunction after Lung Transplantation

R. J. Shah*, J. M. Diamond, E. Cantu, J. Flesch, J. C. Lee, D. J. Lederer, V. N. Lama, J. Orens, A. Weinacker, D. S. Wilkes, D. Roe, S. Bhorade, K. M. Wille, L. B. Ware, S. M. Palmer, M. Crespo, E. Demissie, J. Sonnet, A. Shah, S. M. KawutS. L. Bellamy, A. R. Localio, J. D. Christie

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

Primary graft dysfunction (PGD) is a major cause of early mortality after lung transplant. We aimed to define objective estimates of PGD risk based on readily available clinical variables, using a prospective study of 11 centers in the Lung Transplant Outcomes Group (LTOG). Derivation included 1255 subjects from 2002 to 2010; with separate validation in 382 subjects accrued from 2011 to 2012. We used logistic regression to identify predictors of grade 3 PGD at 48/72 h, and decision curve methods to assess impact on clinical decisions. 211/1255 subjects in the derivation and 56/382 subjects in the validation developed PGD. We developed three prediction models, where low-risk recipients had a normal BMI (18.5-25 kg/m2), chronic obstructive pulmonary disease/cystic fibrosis, and absent or mild pulmonary hypertension (mPAP<40 mmHg). All others were considered higher-risk. Low-risk recipients had a predicted PGD risk of 4-7%, and high-risk a predicted PGD risk of 15-18%. Adding a donor-smoking lung to a higher-risk recipient significantly increased PGD risk, although risk did not change in low-risk recipients. Validation demonstrated that probability estimates were generally accurate and that models worked best at baseline PGD incidences between 5% and 25%. We conclude that valid estimates of PGD risk can be produced using readily available clinical variables.

Original languageEnglish (US)
Pages (from-to)2188-2196
Number of pages9
JournalAmerican Journal of Transplantation
Volume15
Issue number8
DOIs
StatePublished - Aug 1 2015

Keywords

  • clinical research / practice
  • lung (allograft) function / dysfunction
  • lung failure / injury
  • lung transplantation / pulmonology

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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