title: Objective Estimates Improve Risk Stratification for Primary Graft Dysfunction after Lung Transplantation.
abstract: Primary graft dysfunction (PGD) is a major cause of early mortality after lung transplant. We aimed to define objective estimates of PGD risk based on readily available clinical variables, using a prospective study of 11 centers in the Lung Transplant Outcomes Group (LTOG). Derivation included 1255 subjects from 2002 to 2010; with separate validation in 382 subjects accrued from 2011 to 2012. We used logistic regression to identify predictors of grade 3 PGD at 48/72 h, and decision curve methods to assess impact on clinical decisions. 211/1255 subjects in the derivation and 56/382 subjects in the validation developed PGD. We developed three prediction models, where low-risk recipients had a normal BMI (18.5-25 kg/m(2) ), chronic obstructive pulmonary disease/cystic fibrosis, and absent or mild pulmonary hypertension (mPAP<40 mmHg). All others were considered higher-risk. Low-risk recipients had a predicted PGD risk of 4-7%, and high-risk a predicted PGD risk of 15-18%. Adding a donor-smoking lung to a higher-risk recipient significantly increased PGD risk, although risk did not change in low-risk recipients. Validation demonstrated that probability estimates were generally accurate and that models worked best at baseline PGD incidences between 5% and 25%. We conclude that valid estimates of PGD risk can be produced using readily available clinical variables.
authors: Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA.|Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors: R J
authors: RJ
authors: Shah
authors: Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA.|Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors: J M
authors: JM
authors: Diamond
authors: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors: E
authors: E
authors: Cantu
authors: Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA.|Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors: J
authors: J
authors: Flesch
authors: Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors: J C
authors: JC
authors: Lee
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
authors: D J
authors: DJ
authors: Lederer
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Michigan, Ann Arbor, MI.
authors: V N
authors: VN
authors: Lama
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Johns Hopkins University Hospital, Baltimore, MD.
authors: J
authors: J
authors: Orens
authors: Department of Pulmonary and Critical Care, Stanford University, Palo Alto, CA.
authors: A
authors: A
authors: Weinacker
authors: Division of Pulmonary, and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors: D S
authors: DS
authors: Wilkes
authors: Division of Pulmonary, and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors: D
authors: D
authors: Roe
authors: Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL.
authors: S
authors: S
authors: Bhorade
authors: Division of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors: K M
authors: KM
authors: Wille
authors: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors: L B
authors: LB
authors: Ware
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, NC.
authors: S M
authors: SM
authors: Palmer
authors: Division of Pulmonary, Allergy, and Critical Care, University of Pittsburgh, Pittsburgh, PA.
authors: M
authors: M
authors: Crespo
authors: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors: E
authors: E
authors: Demissie
authors: Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY.
authors: J
authors: J
authors: Sonnet
authors: Department of Surgery, Johns Hopkins University Hospital, Baltimore, MD.
authors: A
authors: A
authors: Shah
authors: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors: S M
authors: SM
authors: Kawut
authors: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors: S L
authors: SL
authors: Bellamy
authors: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors: A R
authors: AR
authors: Localio
authors: Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA.|Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors: J D
authors: JD
authors: Christie
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D055031:Primary Graft Dysfunction; D012307:Risk Factors
keywords: clinical research / practice; lung (allograft) function / dysfunction; lung failure / injury; lung transplantation / pulmonology