title: Pretransplant dyslipidaemia influences primary graft dysfunction after lung transplantation.
abstract: OBJECTIVE
  Primary graft dysfunction (PGD) is a major cause of mortality within the first year following lung transplantation. Pulmonary hypertension, elevated body mass index (BMI), prolonged ischaemic time of the graft, intraoperative blood transfusions >1000 ml and the use of cardiopulmonary bypass or extracorporeal membrane oxygenation increase the risk for PGD. We aimed to evaluate whether dyslipidaemia is an additional risk factor for the development of PGD.
  
  
  METHODS
  We retrospectively analysed demographic and clinical data of 264 patients who received their first bilateral lung transplantation between March 2000 and October 2013 at our institution. The endpoint was PGD grade 3 at any time, defined according to the International Society for Heart and Lung Transplantation (ISHLT) criteria. Fasting lipid profiles at listing time or just before transplantation (baseline) were documented and dyslipidaemia was defined as any of the parameters being out of range. Comparisons of continuous variables between patients with PGD grade 3 and patients without were performed with the Mann-Whitney U-test, whereas proportions were compared with the χ(2) test. Continuous variables were presented as arithmetic means with standard deviation for ease of comparison, but levels of statistical significance were computed using the appropriate non-parametric statistical test. To identify PGD risk factors, a forward stepwise logistic regression model was used.
  
  
  RESULTS
  PGD occurred in 63 recipients (24%). Pretransplant dyslipidaemia was documented in 153 recipients (58%) and was significantly more prevalent among recipients developing PGD (45 vs 108, P < 0.013). Despite various underlying pulmonary pathologies, higher triglyceride (TG) levels (1.41 ± 0.78 vs 1.16 ± 0.78, P < 0.012), lower high-density lipoprotein-cholesterol (HDL-C) concentrations (1.24 ± 0.55 vs 1.57 ± 0.71, P < 0.0005) and higher cholesterol/HDL-C values (3.80 ± 2.02 vs 3.00 ± 0.92, P < 0.0005) were associated with a lower incidence of PGD. Patients with PGD had significantly longer ischaemic time (350 ± 89 vs 322 ± 91, P = 0.017) and higher BMI (23 ± 5 vs 21 ± 4.4, P < 0.007).
  
  
  CONCLUSIONS
  Dyslipidaemia seems to be an independent risk factor for PGD after lung transplantation: low circulating levels of HDL-C and hypertriglyceridaemia increase the incidence of PGD. Even if HDL-C levels are difficult to alter today, triglyceride and cholesterol levels can be addressed therapeutically and may have a positive influence on the development of PGD.
authors.affiliation: Surgical Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland silvia.cottini@usz.ch.
authors.forename: Silvia R
authors.initials: SR
authors.lastname: Cottini
authors.affiliation: Surgical Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Ulrike E
authors.initials: UE
authors.lastname: Ehlers
authors.affiliation: Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC), Intensive Care Unit of Regional Hospital of Mendrisio, Mendrisio, Switzerland.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pagnamenta
authors.affiliation: Surgical Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Brandi
authors.affiliation: Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
authors.affiliation: Surgical Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Reto A
authors.initials: RA
authors.lastname: Schuepbach
authors.affiliation: Surgical Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland Swiss Paraplegic Center, Nottwil, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Béchir
authors.affiliation: Division of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Benden
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D050171:Dyslipidemias / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008055:Lipids / Q000097:blood*; D016015:Logistic Models; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D055031:Primary Graft Dysfunction / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D065840:Protective Factors; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D000960:Hypolipidemic Agents; D008055:Lipids
keywords: Dyslipidaemia; Inflammation; Lung transplantation; Primary graft dysfunction