RATIONALE: Primary graft dysfunction is a severe acute lung injury syndrome after lung transplantation. Long-term outcomes of subjects with primary graft dysfunction have not been studied. OBJECTIVES: We sought to test the relationship of primary graft dysfunction with both short- and long-term mortality using a large registry. METHODS: We used data collected on 5,262 patients in the United Network for Organ Sharing/International Society of Heart and Lung Transplantation registry between 1994 and 2000. We assessed outcomes in all subjects; to assess potential bias from the effects of early mortality, we also evaluated subjects who survived at least 1 year, using Cox proportional hazards models with time-varying covariates. MAIN RESULTS: The overall incidence of primary graft dysfunction was 10.2% (95% confidence intervals [CI], 9.2, 10.9). The incidence did not vary by year over the period of observation (p = 0.22). All-cause mortality at 30 days was 42.1% for primary graft dysfunction versus 6.1% in patients without graft dysfunction (relative risk = 6.95; 95% CI, 5.98, 8.08; p < 0.001); among subjects who died by 30 days, 43.6% had primary graft dysfunction. Among patients surviving at least 1 year, those who had primary graft dysfunction had significantly worse survival over ensuing years (hazard ratio, 1.35; 95% CI, 1.07, 1.70; p = 0.011). Adjustment for clinical variables including bronchiolitis obliterans syndrome did not change this relationship. CONCLUSION: Primary graft dysfunction contributes to nearly half of the short-term mortality after lung transplantation. Survivors of primary graft dysfunction have increased risk of death extending beyond the first post-transplant year.
RATIONALE: Primary graft dysfunction is a severe acute lung injury syndrome after lung transplantation. Long-term outcomes of subjects with primary graft dysfunction have not been studied. OBJECTIVES: We sought to test the relationship of primary graft dysfunction with both short- and long-term mortality using a large registry. METHODS: We used data collected on 5,262 patients in the United Network for Organ Sharing/International Society of Heart and Lung Transplantation registry between 1994 and 2000. We assessed outcomes in all subjects; to assess potential bias from the effects of early mortality, we also evaluated subjects who survived at least 1 year, using Cox proportional hazards models with time-varying covariates. MAIN RESULTS: The overall incidence of primary graft dysfunction was 10.2% (95% confidence intervals [CI], 9.2, 10.9). The incidence did not vary by year over the period of observation (p = 0.22). All-cause mortality at 30 days was 42.1% for primary graft dysfunction versus 6.1% in patients without graft dysfunction (relative risk = 6.95; 95% CI, 5.98, 8.08; p < 0.001); among subjects who died by 30 days, 43.6% had primary graft dysfunction. Among patients surviving at least 1 year, those who had primary graft dysfunction had significantly worse survival over ensuing years (hazard ratio, 1.35; 95% CI, 1.07, 1.70; p = 0.011). Adjustment for clinical variables including bronchiolitis obliterans syndrome did not change this relationship. CONCLUSION:Primary graft dysfunction contributes to nearly half of the short-term mortality after lung transplantation. Survivors of primary graft dysfunction have increased risk of death extending beyond the first post-transplant year.
Authors: Marshall I Hertz; David O Taylor; Elbert P Trulock; Mark M Boucek; Paul J Mohacsi; Leah B Edwards; Berkeley M Keck Journal: J Heart Lung Transplant Date: 2002-09 Impact factor: 10.247
Authors: Elbert P Trulock; Leah B Edwards; David O Taylor; Mark M Boucek; Berkeley M Keck; Marshall I Hertz Journal: J Heart Lung Transplant Date: 2004-07 Impact factor: 10.247
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Authors: Steven M Fiser; Curtis G Tribble; Stewart M Long; Aditya K Kaza; John A Kern; David R Jones; Mark K Robbins; Irving L Kron Journal: Ann Thorac Surg Date: 2002-04 Impact factor: 4.330
Authors: R C King; O A Binns; F Rodriguez; R C Kanithanon; T M Daniel; W D Spotnitz; C G Tribble; I L Kron Journal: Ann Thorac Surg Date: 2000-06 Impact factor: 4.330
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Authors: 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 Kawut; S L Bellamy; A R Localio; J D Christie Journal: Am J Transplant Date: 2015-04-15 Impact factor: 8.086
Authors: D J Lederer; S M Arcasoy; R G Barr; J S Wilt; E Bagiella; F D'Ovidio; J R Sonett; S M Kawut Journal: Am J Transplant Date: 2006-07-26 Impact factor: 8.086
Authors: Silvia R Cottini; Urs Wenger; Susanne Sailer; Paul A Stehberger; Reto A Schuepbach; Peter Hasenclever; Markus Wilhelm; Markus Béchir Journal: J Extra Corpor Technol Date: 2013-03
Authors: Joshua M Diamond; Tatiana Akimova; Altaf Kazi; Rupal J Shah; Edward Cantu; Rui Feng; Matthew H Levine; Steven M Kawut; Nuala J Meyer; James C Lee; Wayne W Hancock; Richard Aplenc; Lorraine B Ware; Scott M Palmer; Sangeeta Bhorade; Vibha N Lama; Ann Weinacker; Jonathan Orens; Keith Wille; Maria Crespo; David J Lederer; Selim Arcasoy; Ejigayehu Demissie; Jason D Christie Journal: Am J Respir Crit Care Med Date: 2014-03-01 Impact factor: 21.405