Soluble p-selectin and the risk of primary graft dysfunction after lung transplantation.
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 (Pao(2)/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.


CONCLUSIONS
Higher postoperative soluble P-selectin levels were associated with an increased risk of PGD at 72 h following lung transplantation.
Kawut
Steven M
SM
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA. Electronic address: kawut@mail.med.upenn.edu.
Okun
Jeffrey
J
Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY.
Shimbo
Daichi
D
Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY.
Lederer
David J
DJ
Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY.
De Andrade
Joao
J
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Lama
Vibha
V
Department of Medicine, University of Michigan, Ann Arbor, MI.
Shah
Ashish
A
Department of Surgery, Johns Hopkins University, Baltimore, MD.
Milstone
Aaron
A
Department of Medicine, Vanderbilt University, Nashville, TN.
Ware
Lorraine B
LB
Department of Medicine, Vanderbilt University, Nashville, TN.
Weinacker
Ann
A
Department of Medicine, Stanford University, Stanford, CA.
Demissie
Ejigayehu
E
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.
Christie
Jason D
JD
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008171:Lung Diseases / Q000097:blood* / Q000473:pathology / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood*; D015539:Platelet Activation; D055031:Primary Graft Dysfunction / Q000097:blood* / Q000209:etiology*; D012307:Risk Factors
D019007:P-Selectin