0
Clinical Investigations: LUNG TRANSPLANTATION |

Clinical Risk Factors for Primary Graft Failure Following Lung Transplantation*

Jason D. Christie; Robert M. Kotloff; Alberto Pochettino; Selim M. Arcasoy; Bruce R. Rosengard; J. Richard Landis; Stephen E. Kimmel
Author and Funding Information

*From the Division of Pulmonary and Critical Care Medicine (Drs. Christie and Kotloff), Department of Medicine, University of Pennsylvania School of Medicine; Department of Biostatistics and Epidemiology (Drs. Landis and Kimmel), University of Pennsylvania School of Medicine; Division of Pulmonary and Critical Care Medicine (Dr. Arcasoy), Department of Medicine, Columbia University College of Physicians and Surgeons; and Division of Thoracic Surgery, Department of Surgery (Drs. Pochettino and Rosengard), University of Pennsylvania School of Medicine, Philadelphia, PA.

Correspondence to: Jason D. Christie, MD, MS, Assistant Professor of Medicine and Epidemiology, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 423 Guardian Dr, 719 Blockley Hall, Philadelphia, PA 19104; e-mail: jchristi@cceb.med.upenn.edu



Chest. 2003;124(4):1232-1241. doi:10.1378/chest.124.4.1232
Text Size: A A A
Published online

Study objectives: Primary graft failure (PGF) is a devastating acute lung injury syndrome following lung transplantation. We sought to identify donor, recipient, and operative risk factors for its development.

Design: We conducted a cohort study of 255 consecutive lung transplant procedures performed between October 1991 and July 2000. We defined PGF as follows: (1) diffuse alveolar opacities exclusively involving allograft(s) and developing within 72 h of transplant, (2) a ratio of Pao2 to fraction of inspired oxygen < 200 beyond 48 h postoperatively, and (3) no other secondary cause of graft dysfunction identified. Risk factors were assessed individually and adjusted for confounding using multivariable logistic regression models.

Setting: Tertiary-care academic medical center.

Results: The overall incidence was 11.8% (95% confidence interval [CI], 7.9 to 15.9). Following multivariable analysis, the risk factors independently associated with development of PGF were as follows: a recipient diagnosis of primary pulmonary hypertension (PPH; adjusted odds ratio [OR], 4.52; 95% CI, 1.29 to 15.9; p = 0.018), donor female gender (adjusted OR, 4.11; 95% CI, 1.17 to 14.4; p = 0.027), donor African-American race (adjusted OR, 5.56; 95% CI, 1.57 to 19.8; p = 0.008), and donor age < 21 years (adjusted OR, 4.06; 95% CI, 1.34 to 12.3; p = 0.013) and > 45 years (adjusted OR, 6.79; 95% CI, 1.61 to 28.5; p = 0.009).

Conclusions: Recipient diagnosis of PPH, donor African-American race, donor female gender, and donor age are independently and strongly associated with development of PGF.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543