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Original Research: PULMONARY VASCULAR DISEASE |

Elevated Pulmonary Artery Pressure Is a Risk Factor for Primary Graft Dysfunction Following Lung Transplantation for Idiopathic Pulmonary Fibrosis

Adam Fang, MD; Sean Studer, MD, FCCP; Steven M. Kawut, MD, FCCP; Vivek N. Ahya, MD, FCCP; James Lee, MD; Keith Wille, MD; Vibha Lama, MD; Lorraine Ware, MD, FCCP; Jonathan Orens, MD, FCCP; Ann Weinacker, MD, FCCP; Scott M. Palmer, MD, FCCP; Maria Crespo, MD; David J. Lederer, MD, FCCP; Clifford S. Deutschman, MD; Benjamin A. Kohl, MD; Scarlett Bellamy, PhD; Ejigayehu Demissie, MSN; Jason D. Christie, MD, FCCP; for the Lung Transplant Outcomes Group
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Drs Crespo and Fang), University of Pittsburgh, Pittsburgh PA; the Division of Pulmonary and Critical Care Medicine (Dr Studer), Newark Beth Israel Medical Center, Newark, NJ; the Division of Pulmonary, Allergy, and Critical Care Medicine (Drs Kawut, Ahya, Lee, and Christie and Ms Demissie), and the Department of Biostatistics and Epidemiology (Drs Kawut, Bellamy, and Christie and Ms Demissie), University of Pennsylvania School of Medicine, Philadelphia PA; the Division of Pulmonary and Critical Care Medicine (Dr Wille), University of Alabama at Birmingham, Birmingham AL; the Division of Pulmonary, Allergy, and Critical Care Medicine (Dr Lama), University of Michigan; the Division of Pulmonary, Allergy, and Critical Care Medicine (Dr Ware), Vanderbilt University, Nashville TN; the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (Dr Orens), Johns Hopkins University Hospital, Baltimore MD; the Division of Pulmonary and Critical Care Medicine (Dr Weinacker), Stanford University; the Division of Pulmonary, Allergy, and Critical Care Medicine (Dr Palmer), Duke University, Durham NC; the Division of Pulmonary and Critical Care Medicine (Dr Lederer), Columbia University College of Physicians and Surgeons, New York, NY; and the Department of Anesthesia and Critical Care (Drs Deutschman and Kohl), University of Pennsylvania School of Medicine, Philadelphia, PA.

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


For editorial comment see page 741

Funding/Support: This study was funded by the National Institutes of Health [Grants NIH HL04243, NIH HL081619, NIH HL087115, NIH HL67771, NIH HL081332] and the Craig and Elaine Dobbin Pulmonary Research Fund.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(4):782-787. doi:10.1378/chest.09-2806
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Background:  Idiopathic pulmonary fibrosis (IPF) is often associated with elevations in pulmonary artery pressures. Although primary pulmonary arterial hypertension (PAH) has been associated with primary graft dysfunction (PGD), the role of secondary PAH in mediating PGD risk in patients with IPF is incompletely understood. The purpose of this study was to evaluate the relationship between mean pulmonary artery pressure (mPAP) and PGD among patients with IPF.

Methods:  We performed a multicenter prospective cohort study of 126 lung transplant procedures performed for IPF between March 2002 and August 2007. The primary outcome was grade 3 PGD at 72 h after lung transplant. The mPAP was measured as the initial reading following insertion of the right-sided heart catheter during lung transplant. Multivariable logistic regression was used to adjust for confounding variables.

Results:  The mPAP for patients with PGD was 38.5 ± 16.3 mm Hg vs 29.6 ± 11.5 mm Hg for patients without PGD (mean difference, 8.9 mm Hg [95% CI, 3.6-14.2]; P = .001). The increase in odds of PGD associated with each 10-mm Hg increase in mPAP was 1.64 (95% CI, 1.18-2.26; P = .003). In multivariable models, this relationship was independent of confounding by other clinical variables, although the use of cardiopulmonary bypass partially attenuated the relationship.

Conclusions:  Higher mPAP in patients with IPF is associated with the development of PGD.

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