title: Elevated pulmonary artery pressure is a risk factor for primary graft dysfunction following lung transplantation for idiopathic pulmonary fibrosis.
abstract: 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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh PA.
authors.forename: Adam
authors.initials: A
authors.lastname: Fang
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Newark Beth Israel Medical Center, Newark, NJ.
authors.forename: Sean
authors.initials: S
authors.lastname: Studer
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia PA; Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia PA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kawut
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia PA.
authors.forename: Vivek N
authors.initials: VN
authors.lastname: Ahya
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia PA.
authors.forename: James
authors.initials: J
authors.lastname: Lee
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, Birmingham AL.
authors.forename: Keith
authors.initials: K
authors.lastname: Wille
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Michigan, Nashville TN.
authors.forename: Vibha
authors.initials: V
authors.lastname: Lama
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University, Nashville TN.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Ware
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Johns Hopkins University Hospital, Baltimore MD.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Orens
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Stanford University, Durham NC.
authors.forename: Ann
authors.initials: A
authors.lastname: Weinacker
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham NC.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Palmer
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh PA.
authors.forename: Maria
authors.initials: M
authors.lastname: Crespo
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
authors.affiliation: Department of Anesthesia and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Deutschman
authors.affiliation: Department of Anesthesia and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Kohl
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia PA.
authors.forename: Scarlett
authors.initials: S
authors.lastname: Bellamy
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia PA; Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia PA.
authors.forename: Ejigayehu
authors.initials: E
authors.lastname: Demissie
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia PA; Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia PA. Electronic address: jchristi@mail.med.upenn.edu.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000503:physiopathology; D054990:Idiopathic Pulmonary Fibrosis / Q000503:physiopathology / Q000601:surgery*; D015994:Incidence; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012307:Risk Factors