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Original Research: LUNG TRANSPLANTATION |

Soluble P-Selectin and the Risk of Primary Graft Dysfunction After Lung Transplantation

Steven M. Kawut, MD, MS, FCCP; Jeffrey Okun, BS; Daichi Shimbo, MD; David J. Lederer, MD, MS; Joao De Andrade, MD; Vibha Lama, MD; Ashish Shah, MD; Aaron Milstone, MD; Lorraine B. Ware, MD, FCCP; Ann Weinacker, MD; Ejigayehu Demissie, MSN; Jason D. Christie, MD, MS, FCCP; for the Lung Transplant Outcomes Group
Author and Funding Information

From the Department of Medicine (Drs. Kawut and Christie, and Ms. Demissie), University of Pennsylvania School of Medicine, Philadelphia, PA; the Department of Medicine (Drs. Shimbo and Lederer, and Mr. Okun), Columbia University College of Physicians and Surgeons, New York City, NY; the Department of Medicine (Dr. De Andrade), University of Alabama at Birmingham, Birmingham, AL; the Department of Medicine (Dr. Lama), University of Michigan, Ann Arbor, MI; the Department of Surgery (Dr. Shah), Johns Hopkins University, Baltimore, MD; the Department of Medicine (Drs. Milstone and Ware), Vanderbilt University, Nashville, TN; and the Department of Medicine (Dr. Weinacker), Stanford University, Stanford, CA.

Correspondence to: Steven M. Kawut, MD, MS, FCCP, Cardiovascular Institute, Center for Clinical Epidemiology and Biostatistics, Pulmonary, Allergy and Critical Care Division, University of Pennsylvania School of Medicine, 711 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104; e-mail: kawut@mail.med.upenn.edu


This research was supported by National Institutes of Health grants HL04243, HL067771, HL081332, HL087115, and HL081619.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


© 2009 American College of Chest Physicians


Chest. 2009;136(1):237-244. doi:10.1378/chest.08-2697
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Background:  Platelet activation with subsequent neutrophilic adherence to the vasculature initiates ischemia-reperfusion injury. We hypothesized that higher plasma P-selectin levels reflecting platelet activation would therefore be associated with primary graft dysfunction (PGD) after lung transplantation.

Methods:  In a prospective, multicenter cohort study of 376 patients who had undergone lung transplantation between 2002 and 2007, we measured soluble P-selectin levels before lung transplantation and at 6 and 24 h after lung reperfusion in 20 patients with grade III PGD (Pao2/fraction of inspired oxygen, < 200 mm Hg [with alveolar infiltrates seen on chest radiographs]) at 72 h after transplantation and 61 control subjects without PGD.

Results:  Higher postoperative soluble P-selectin levels were associated with an increased risk of PGD at 72 h after transplantation (odds ratio [OR] per 1 natural log increase in soluble P-selectin at 6 h after lung allograft reperfusion, 3.5; 95% confidence interval [CI], 1.01 to 11.8; p = 0.048) and at 24 h after lung allograft reperfusion (OR, 4.8; 95% CI, 1.4 to 16.1; p = 0.01). Higher preoperative mean pulmonary artery pressure and the use of cardiopulmonary bypass were also associated with an increased risk of PGD.

Conclusion:  Higher postoperative soluble P-selectin levels were associated with an increased risk of PGD at 72 h following lung transplantation.

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