title: C1-esterase-inhibitor for primary graft dysfunction in lung transplantation.
abstract: BACKGROUND
  Primary graft dysfunction (PGD) is the most important cause of early morbidity and mortality in lung transplantation (LTX) with an incidence of 8% to 20%. We hypothesized that application of C1-esterase-inhibitor (C1-INH) in LTX-recipients showing early signs of severe PGD would attenuate the condition.
  
  
  METHODS
  Starting as of May 2010, all recipients showing a PaO2/FiO2 ratio of less than 100 as early sign of PGD at first measurement in the OR were immediately treated with C1-INH. Postoperative courses of C1-INH-treated recipients were compared with a subgroup of recipients that developed severe PGD (PGD3-group) within 72 hours after LTX but did not receive C1-INH. Additionally, a third group consisting of all remaining recipients was assembled.
  
  
  RESULTS
  A total of 275 LTX were performed between May 2010 and September 2012 at our center. Among these, 24 patients (8.7%) revealed a first PaO2/FiO2 ratio less than 100 and were treated with C1-INH (C1-INH-group). The PGD3-group consisted of 14 patients; the control cohort consisted of 237 patients. PGD scores were significantly higher in the C1-INH-group and PGD3-group as compared with the control group at all times postoperatively. ICU stay was longest in the PGD3 cohort and prolonged in C1-INH patients compared with the control group (29 [2-70] vs. 9 [2-83] vs. 3 [1-166] days, P=0.002). One-year survival in the PGD3-cohort was 71.4%, the C1-INH-treated-group had a one-year-survival of 82.5%, the control group had the best outcome (95%) (P=0.001).
  
  
  CONCLUSIONS
  Treatment of PGD with C1-INH led to acceptable outcome. Although survival in the C1-INH treated patients was lower than in the remaining collective, it was as good or better, compared with the PGD3 group and as what is internationally regarded as reasonable after LTX.
authors.affiliation: 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany. 2 Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany. 3 Member of the German Centre for Lung Research. 4 Department of Anaesthesiology, Hannover Medical School, Hannover, Germany. 5 Address correspondence to: Gregor Warnecke, M.D., Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Member of the German Centre for Lung Research, Carl-Neuberg-Str.1, 30625 Hannover, Germany.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Sommer
authors.forename: Igor
authors.initials: I
authors.lastname: Tudorache
authors.forename: Christian
authors.initials: C
authors.lastname: Kühn
authors.forename: Murat
authors.initials: M
authors.lastname: Avsar
authors.forename: Jawad
authors.initials: J
authors.lastname: Salman
authors.forename: Fabio
authors.initials: F
authors.lastname: Ius
authors.forename: Clemens
authors.initials: C
authors.lastname: Gras
authors.forename: Petra
authors.initials: P
authors.lastname: Weber
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: Jens
authors.initials: J
authors.lastname: Gottlieb
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D050718:Complement C1 Inhibitor Protein / Q000627:therapeutic use*; D051056:Complement Inactivating Agents / Q000627:therapeutic use; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008171:Lung Diseases / Q000188:drug therapy*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D056687:Off-Label Use; D011184:Postoperative Period; D055031:Primary Graft Dysfunction / Q000188:drug therapy*; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D050718:Complement C1 Inhibitor Protein; D051056:Complement Inactivating Agents