Elevated pulmonary artery pressure is a risk factor for primary graft dysfunction following lung transplantation for idiopathic pulmonary fibrosis.
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.
Fang
Adam
A
Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh PA.
Studer
Sean
S
Division of Pulmonary and Critical Care Medicine, Newark Beth Israel Medical Center, Newark, NJ.
Kawut
Steven M
SM
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.
Ahya
Vivek N
VN
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia PA.
Lee
James
J
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia PA.
Wille
Keith
K
Division of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, Birmingham AL.
Lama
Vibha
V
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Michigan, Nashville TN.
Ware
Lorraine
L
Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University, Nashville TN.
Orens
Jonathan
J
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Johns Hopkins University Hospital, Baltimore MD.
Weinacker
Ann
A
Division of Pulmonary and Critical Care Medicine, Stanford University, Durham NC.
Palmer
Scott M
SM
Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham NC.
Crespo
Maria
M
Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh PA.
Lederer
David J
DJ
Division of Pulmonary and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
Deutschman
Clifford S
CS
Department of Anesthesia and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA.
Kohl
Benjamin A
BA
Department of Anesthesia and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA.
Bellamy
Scarlett
S
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia PA.
Demissie
Ejigayehu
E
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.
Christie
Jason D
JD
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.
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