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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.

SUBMITTER: Shah RJ 

PROVIDER: S-EPMC4721238 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

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Objective Estimates Improve Risk Stratification for Primary Graft Dysfunction after Lung Transplantation.

Shah R J RJ   Diamond J M JM   Cantu E E   Flesch J J   Lee J C JC   Lederer D J DJ   Lama V N VN   Orens J J   Weinacker A A   Wilkes D S DS   Roe D D   Bhorade S S   Wille K M KM   Ware L B LB   Palmer S M SM   Crespo M M   Demissie E E   Sonnet J J   Shah A A   Kawut S M SM   Bellamy S L SL   Localio A R AR   Christie J D JD  

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 20150415 8


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  ...[more]

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