Michael Eberlein1, Robert M Reed2, Servet Bolukbas3, Joshua M Diamond4, Keith M Wille5, Jonathan B Orens6, Roy G Brower6, Jason D Christie4. 1. Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: michael-eberlein@uiowa.edu. 2. Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland. 3. Department of Thoracic Surgery, Dr. Horst Schmidt Klinik, Wiesbaden, Germany. 4. Division of Pulmonary and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 5. Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama. 6. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
Abstract
BACKGROUND: Donor-to-recipient lung size matching at lung transplantation (LTx) can be estimated by the predicted total lung capacity (pTLC) ratio (donor pTLC/recipient pTLC). We aimed to determine whether the pTLC ratio is associated with the risk of primary graft dysfunction (PGD) after bilateral LTx (BLT). METHODS: We calculated the pTLC ratio for 812 adult BLTs from the Lung Transplant Outcomes Group between March 2002 to December 2010. Patients were stratified by pTLC ratio >1.0 ("oversized") and pTLC ratio ≤1.0 ("undersized"). PGD was defined as any ISHLT Grade 3 PGD (PGD3) within 72 hours of reperfusion. We analyzed the association between risk factors and PGD using multivariable conditional logistic regression. As transplant diagnoses can influence the size-matching decisions and also modulate the risk for PGD, we performed pre-specified analyses by assessing the impact of lung size mismatch within diagnostic categories. RESULTS: In univariate analyses oversizing was associated with a 39% lower odds of PGD3 (OR 0.61, 95% CI, 0.45-0.85, p = 0.003). In a multivariate model accounting for center-effects and known PGD risks, oversizing remained independently associated with a decreased odds of PGD3 (OR 0.58, 95% CI 0.38 to 0.88, p = 0.01). The risk-adjusted point estimate was similar for the non-COPD diagnosis groups (OR 0.52, 95% CI 0.32 to 0.86, p = 0.01); however, there was no detected association within the COPD group (OR 0.72, 95% CI 0.29 to 1.78, p = 0.5). CONCLUSION: Oversized allografts are associated with a decreased risk of PGD3 after BLT; this effect appears most apparent in non-COPD patients.
BACKGROUND:Donor-to-recipient lung size matching at lung transplantation (LTx) can be estimated by the predicted total lung capacity (pTLC) ratio (donor pTLC/recipient pTLC). We aimed to determine whether the pTLC ratio is associated with the risk of primary graft dysfunction (PGD) after bilateral LTx (BLT). METHODS: We calculated the pTLC ratio for 812 adult BLTs from the Lung Transplant Outcomes Group between March 2002 to December 2010. Patients were stratified by pTLC ratio >1.0 ("oversized") and pTLC ratio ≤1.0 ("undersized"). PGD was defined as any ISHLT Grade 3 PGD (PGD3) within 72 hours of reperfusion. We analyzed the association between risk factors and PGD using multivariable conditional logistic regression. As transplant diagnoses can influence the size-matching decisions and also modulate the risk for PGD, we performed pre-specified analyses by assessing the impact of lung size mismatch within diagnostic categories. RESULTS: In univariate analyses oversizing was associated with a 39% lower odds of PGD3 (OR 0.61, 95% CI, 0.45-0.85, p = 0.003). In a multivariate model accounting for center-effects and known PGD risks, oversizing remained independently associated with a decreased odds of PGD3 (OR 0.58, 95% CI 0.38 to 0.88, p = 0.01). The risk-adjusted point estimate was similar for the non-COPD diagnosis groups (OR 0.52, 95% CI 0.32 to 0.86, p = 0.01); however, there was no detected association within the COPD group (OR 0.72, 95% CI 0.29 to 1.78, p = 0.5). CONCLUSION: Oversized allografts are associated with a decreased risk of PGD3 after BLT; this effect appears most apparent in non-COPDpatients.
Authors: Michael Eberlein; Robert M Reed; Servet Bolukbas; Kalpaj R Parekh; George J Arnaoutakis; Jonathan B Orens; Roy G Brower; Ashish S Shah; Lawrence Hunsicker; Christian A Merlo Journal: Ann Thorac Surg Date: 2013-06-26 Impact factor: 4.330
Authors: Michael Eberlein; Robert M Reed; Solbert Permutt; Mayy F Chahla; Servet Bolukbas; Steven D Nathan; Aldo Iacono; David B Pearse; Henry E Fessler; Ashish S Shah; Jonathan B Orens; Roy G Brower Journal: J Heart Lung Transplant Date: 2011-10-28 Impact factor: 10.247
Authors: Rebecca Dezube; George J Arnaoutakis; Robert M Reed; Servet Bolukbas; Ashish S Shah; Jonathan B Orens; Roy G Brower; Michael Eberlein Journal: Interact Cardiovasc Thorac Surg Date: 2012-12-12
Authors: Norihisa Shigemura; Jonathan D'Cunha; Jay K Bhama; Akira Shiose; Ashraf Abou El Ela; Amy Hackmann; Diana Zaldonis; Yoshiya Toyoda; Joseph M Pilewski; James D Luketich; Christian A Bermudez Journal: Ann Thorac Surg Date: 2013-06-15 Impact factor: 4.330
Authors: Michael Eberlein; Evan Diehl; Servet Bolukbas; Christian A Merlo; Robert M Reed Journal: J Heart Lung Transplant Date: 2013-07-19 Impact factor: 10.247
Authors: Michael Eberlein; Robert M Reed; Michael Maidaa; Servet Bolukbas; George J Arnaoutakis; Jonathan B Orens; Roy G Brower; Christian A Merlo; Lawrence G Hunsicker Journal: Ann Am Thorac Soc Date: 2013-10
Authors: Joshua M Diamond; James C Lee; Steven M Kawut; Rupal J Shah; A Russell Localio; Scarlett L Bellamy; David J Lederer; Edward Cantu; Benjamin A Kohl; Vibha N Lama; Sangeeta M Bhorade; Maria Crespo; Ejigayehu Demissie; Joshua Sonett; Keith Wille; Jonathan Orens; Ashish S Shah; Ann Weinacker; Selim Arcasoy; Pali D Shah; David S Wilkes; Lorraine B Ware; Scott M Palmer; Jason D Christie Journal: Am J Respir Crit Care Med Date: 2013-01-10 Impact factor: 21.405
Authors: Gabriel Loor; Roland Brown; Rosemary F Kelly; Kyle D Rudser; Sara J Shumway; Irena Cich; Christopher T Holley; Colleen Quinlan; Marshall I Hertz Journal: Clin Transplant Date: 2017-02-08 Impact factor: 2.863
Authors: Hisham Taher; Christian Bauer; Eric Abston; David W Kaczka; Surya P Bhatt; Joseph Zabner; Roy G Brower; Reinhard R Beichel; Michael Eberlein Journal: J Appl Physiol (1985) Date: 2018-01-04
Authors: Jason M Gauthier; Andrew J Bierhals; Jingxia Liu; Keki R Balsara; Christine Frederiksen; Emily Gremminger; Ramsey R Hachem; Chad A Witt; Elbert P Trulock; Derek E Byers; Roger D Yusen; Patrick R Aguilar; Gary Marklin; Ruben G Nava; Benjamin D Kozower; Michael K Pasque; Bryan F Meyers; G Alexander Patterson; Daniel Kreisel; Varun Puri Journal: J Thorac Cardiovasc Surg Date: 2018-11-24 Impact factor: 5.209
Authors: Daniel C Chambers; Wida S Cherikh; Michael O Harhay; Don Hayes; Eileen Hsich; Kiran K Khush; Bruno Meiser; Luciano Potena; Joseph W Rossano; Alice E Toll; Tajinder P Singh; Aparna Sadavarte; Andreas Zuckermann; Josef Stehlik Journal: J Heart Lung Transplant Date: 2019-08-08 Impact factor: 10.247
Authors: Don Hayes; Wida S Cherikh; Daniel C Chambers; Michael O Harhay; Kiran K Khush; Rebecca R Lehman; Bruno Meiser; Joseph W Rossano; Eileen Hsich; Luciano Potena; Aparna Sadavarte; Tajinder P Singh; Andreas Zuckermann; Josef Stehlik Journal: J Heart Lung Transplant Date: 2019-08-08 Impact factor: 10.247