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Transplantation |

The Relationship Between Red Cell Distribution Width and Mortality After Lung Transplantation

Adrien Mazer*, MD; Margaret Fregoso, MSN; Shahzad Ahmad, MD; Anne Brown, MD; Oksana Shlobin, MD; Nargues Weir, MD; Steven Nathan, MD
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Georgetown University Hospital, Washington, DC


Chest. 2012;142(4_MeetingAbstracts):1095A. doi:10.1378/chest.1357174
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Abstract

SESSION TYPE: Lung Transplantation Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Elevated red cell distribution width (RDW) has been demonstrated to be associated with adverse outcomes in several different patient populations. Our objective was to assess whether elevated RDW levels were associated with increased mortality in lung transplant patients.

METHODS: Patients who underwent lung transplantation between 1996 and 2011 were identified. Pre-transplant RDW (RDWpre) levels were collected on the day of the transplant from the pre-operative complete blood count. Post-transplant RDWs from 6 (RDW6) and 12 (RDW12) months were also collected. Patients were stratified by RDWs at each time interval into elevated (>15) and normal (<15) groups with the primary outcome measure being mortality from the date of the blood draw. Serial change in the RDW from pre-transplant to 12 months post-transplant (ΔRDW) was also evaluated as a predictor of mortality. Survival was compared with Kaplan-Meier curves.

RESULTS: There were 284 transplant recipients with evaluable data. Patients with RDWpre >15 (N=63) and <15 (N=210) had median survival rates of 62.17 and 54.57 months, respectively (p=0.56). Patients with RDW6 >15 (N=115) and <15 (N=121) had median survival rates of 50.07 and 58.93 months, respectively (p=0.09). Patients with RDW12 >15 (N=78) and <15 (N=131) had median survival rates of 40.57 and 56.63 months, respectively (p=0.01). Patients with a ΔRDW of <0 (N=72) and >0 (N=132) had median survival rates of 58.00 and 45.43 months, respectively (p=0.05). Patients with a ΔRDW of <0.5 (N=102) and >0.5 (N=102) and ΔRDW of <1 (N=125) and >1 (N=79) had median survival rates of 58.00 and 42.57 (p=0.004) and 56.53 and 36.60 (p=0.002) months, respectively.

CONCLUSIONS: Although the pre-transplant RDW does not appear to predict subsequent post-transplant outcomes, the post-transplant RDW appears to have very good predictive abilities for subsequent outcomes.

CLINICAL IMPLICATIONS: The ability to risk stratify patients with a readily available biomarker as early as 6 months has obvious appeal in the management of these complicated cases. The biologic basis and whether the RDW is a biomarker for bronchiolitis obliterans syndrome or other specific post-transplant complications requires further study.

DISCLOSURE: The following authors have nothing to disclose: Adrien Mazer, Margaret Fregoso, Shahzad Ahmad, Anne Brown, Oksana Shlobin, Nargues Weir, Steven Nathan

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Georgetown University Hospital, Washington, DC

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