Plasma Receptor for Advanced Glycation End-products Predicts Duration of ICU Stay and Mechanical Ventilation in Patients After Lung Transplantation

Carolyn S. Calfee*, Marie M. Budev, Michael A. Matthay, Gwynne Church, Sandra Brady, Tokujiro Uchida, Akitoshi Ishizaka, Abigail Lara, Justin L. Ranes, Malcom M. deCamp, Alejandro C. Arroliga

*Corresponding author for this work

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background: Primary graft dysfunction, formerly termed reperfusion pulmonary edema, is the leading cause of short-term complications after lung transplantation. New evidence shows that alveolar type I epithelial cells play an active role in alveolar fluid transport and are therefore presumed to be critical in the absorption of pulmonary edema. We tested the potential relevance of a novel marker of alveolar type I cell injury, the receptor for advanced glycation end-products (RAGE), to short-term outcomes of lung transplantation. Methods: The study was a prospective, observational cohort study of 20 patients undergoing single lung, bilateral lung or combined heart-lung transplantation. Plasma biomarkers were measured 4 hours after allograft reperfusion. Results: Higher plasma RAGE levels were associated with a longer duration of mechanical ventilation and longer intensive care unit length of stay, in contrast to markers of alveolar type II cell injury, endothelial injury and acute inflammation. Specifically, for every doubling in plasma RAGE levels, the duration of mechanical ventilation increased on average by 26 hours, adjusting for ischemia time (95% confidence interval [CI] 7.4 to 44.7 hours, p = 0.01). Likewise, for every doubling of plasma RAGE levels, intensive care unit length of stay increased on average by 1.8 days, again adjusting for ischemia time (95% CI 0.13 to 3.45 days p = 0.04). In contrast, the clinical diagnosis of primary graft dysfunction was not as predictive of these short-term outcomes. Conclusions: Higher levels of plasma RAGE measured shortly after reperfusion predicted poor short-term outcomes from lung transplantation. Elevated plasma RAGE levels may have both pathogenetic and prognostic value in patients after lung transplantation.

Original languageEnglish (US)
Pages (from-to)675-680
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume26
Issue number7
DOIs
StatePublished - Jul 1 2007

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Lung Transplantation
Artificial Respiration
Alveolar Epithelial Cells
Primary Graft Dysfunction
Reperfusion
Pulmonary Edema
Intensive Care Units
Length of Stay
Wounds and Injuries
Ischemia
Confidence Intervals
Heart-Lung Transplantation
Lung
Observational Studies
Allografts
Advanced Glycosylation End Product-Specific Receptor
Cohort Studies
Biomarkers
Inflammation

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Calfee, Carolyn S. ; Budev, Marie M. ; Matthay, Michael A. ; Church, Gwynne ; Brady, Sandra ; Uchida, Tokujiro ; Ishizaka, Akitoshi ; Lara, Abigail ; Ranes, Justin L. ; deCamp, Malcom M. ; Arroliga, Alejandro C. / Plasma Receptor for Advanced Glycation End-products Predicts Duration of ICU Stay and Mechanical Ventilation in Patients After Lung Transplantation. In: Journal of Heart and Lung Transplantation. 2007 ; Vol. 26, No. 7. pp. 675-680.
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title = "Plasma Receptor for Advanced Glycation End-products Predicts Duration of ICU Stay and Mechanical Ventilation in Patients After Lung Transplantation",
abstract = "Background: Primary graft dysfunction, formerly termed reperfusion pulmonary edema, is the leading cause of short-term complications after lung transplantation. New evidence shows that alveolar type I epithelial cells play an active role in alveolar fluid transport and are therefore presumed to be critical in the absorption of pulmonary edema. We tested the potential relevance of a novel marker of alveolar type I cell injury, the receptor for advanced glycation end-products (RAGE), to short-term outcomes of lung transplantation. Methods: The study was a prospective, observational cohort study of 20 patients undergoing single lung, bilateral lung or combined heart-lung transplantation. Plasma biomarkers were measured 4 hours after allograft reperfusion. Results: Higher plasma RAGE levels were associated with a longer duration of mechanical ventilation and longer intensive care unit length of stay, in contrast to markers of alveolar type II cell injury, endothelial injury and acute inflammation. Specifically, for every doubling in plasma RAGE levels, the duration of mechanical ventilation increased on average by 26 hours, adjusting for ischemia time (95{\%} confidence interval [CI] 7.4 to 44.7 hours, p = 0.01). Likewise, for every doubling of plasma RAGE levels, intensive care unit length of stay increased on average by 1.8 days, again adjusting for ischemia time (95{\%} CI 0.13 to 3.45 days p = 0.04). In contrast, the clinical diagnosis of primary graft dysfunction was not as predictive of these short-term outcomes. Conclusions: Higher levels of plasma RAGE measured shortly after reperfusion predicted poor short-term outcomes from lung transplantation. Elevated plasma RAGE levels may have both pathogenetic and prognostic value in patients after lung transplantation.",
author = "Calfee, {Carolyn S.} and Budev, {Marie M.} and Matthay, {Michael A.} and Gwynne Church and Sandra Brady and Tokujiro Uchida and Akitoshi Ishizaka and Abigail Lara and Ranes, {Justin L.} and deCamp, {Malcom M.} and Arroliga, {Alejandro C.}",
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Calfee, CS, Budev, MM, Matthay, MA, Church, G, Brady, S, Uchida, T, Ishizaka, A, Lara, A, Ranes, JL, deCamp, MM & Arroliga, AC 2007, 'Plasma Receptor for Advanced Glycation End-products Predicts Duration of ICU Stay and Mechanical Ventilation in Patients After Lung Transplantation', Journal of Heart and Lung Transplantation, vol. 26, no. 7, pp. 675-680. https://doi.org/10.1016/j.healun.2007.04.002

Plasma Receptor for Advanced Glycation End-products Predicts Duration of ICU Stay and Mechanical Ventilation in Patients After Lung Transplantation. / Calfee, Carolyn S.; Budev, Marie M.; Matthay, Michael A.; Church, Gwynne; Brady, Sandra; Uchida, Tokujiro; Ishizaka, Akitoshi; Lara, Abigail; Ranes, Justin L.; deCamp, Malcom M.; Arroliga, Alejandro C.

In: Journal of Heart and Lung Transplantation, Vol. 26, No. 7, 01.07.2007, p. 675-680.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Plasma Receptor for Advanced Glycation End-products Predicts Duration of ICU Stay and Mechanical Ventilation in Patients After Lung Transplantation

AU - Calfee, Carolyn S.

AU - Budev, Marie M.

AU - Matthay, Michael A.

AU - Church, Gwynne

AU - Brady, Sandra

AU - Uchida, Tokujiro

AU - Ishizaka, Akitoshi

AU - Lara, Abigail

AU - Ranes, Justin L.

AU - deCamp, Malcom M.

AU - Arroliga, Alejandro C.

PY - 2007/7/1

Y1 - 2007/7/1

N2 - Background: Primary graft dysfunction, formerly termed reperfusion pulmonary edema, is the leading cause of short-term complications after lung transplantation. New evidence shows that alveolar type I epithelial cells play an active role in alveolar fluid transport and are therefore presumed to be critical in the absorption of pulmonary edema. We tested the potential relevance of a novel marker of alveolar type I cell injury, the receptor for advanced glycation end-products (RAGE), to short-term outcomes of lung transplantation. Methods: The study was a prospective, observational cohort study of 20 patients undergoing single lung, bilateral lung or combined heart-lung transplantation. Plasma biomarkers were measured 4 hours after allograft reperfusion. Results: Higher plasma RAGE levels were associated with a longer duration of mechanical ventilation and longer intensive care unit length of stay, in contrast to markers of alveolar type II cell injury, endothelial injury and acute inflammation. Specifically, for every doubling in plasma RAGE levels, the duration of mechanical ventilation increased on average by 26 hours, adjusting for ischemia time (95% confidence interval [CI] 7.4 to 44.7 hours, p = 0.01). Likewise, for every doubling of plasma RAGE levels, intensive care unit length of stay increased on average by 1.8 days, again adjusting for ischemia time (95% CI 0.13 to 3.45 days p = 0.04). In contrast, the clinical diagnosis of primary graft dysfunction was not as predictive of these short-term outcomes. Conclusions: Higher levels of plasma RAGE measured shortly after reperfusion predicted poor short-term outcomes from lung transplantation. Elevated plasma RAGE levels may have both pathogenetic and prognostic value in patients after lung transplantation.

AB - Background: Primary graft dysfunction, formerly termed reperfusion pulmonary edema, is the leading cause of short-term complications after lung transplantation. New evidence shows that alveolar type I epithelial cells play an active role in alveolar fluid transport and are therefore presumed to be critical in the absorption of pulmonary edema. We tested the potential relevance of a novel marker of alveolar type I cell injury, the receptor for advanced glycation end-products (RAGE), to short-term outcomes of lung transplantation. Methods: The study was a prospective, observational cohort study of 20 patients undergoing single lung, bilateral lung or combined heart-lung transplantation. Plasma biomarkers were measured 4 hours after allograft reperfusion. Results: Higher plasma RAGE levels were associated with a longer duration of mechanical ventilation and longer intensive care unit length of stay, in contrast to markers of alveolar type II cell injury, endothelial injury and acute inflammation. Specifically, for every doubling in plasma RAGE levels, the duration of mechanical ventilation increased on average by 26 hours, adjusting for ischemia time (95% confidence interval [CI] 7.4 to 44.7 hours, p = 0.01). Likewise, for every doubling of plasma RAGE levels, intensive care unit length of stay increased on average by 1.8 days, again adjusting for ischemia time (95% CI 0.13 to 3.45 days p = 0.04). In contrast, the clinical diagnosis of primary graft dysfunction was not as predictive of these short-term outcomes. Conclusions: Higher levels of plasma RAGE measured shortly after reperfusion predicted poor short-term outcomes from lung transplantation. Elevated plasma RAGE levels may have both pathogenetic and prognostic value in patients after lung transplantation.

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U2 - 10.1016/j.healun.2007.04.002

DO - 10.1016/j.healun.2007.04.002

M3 - Article

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SP - 675

EP - 680

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

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ER -