Background

Mechanical ventilation immediately after lung transplantation may impact the development of primary graft dysfunction (PGD), particularly in cases of donor-recipient size mismatch as ventilation is typically based on recipient rather than donor size.

Methods

We conducted a retrospective cohort study of adult bilateral lung transplant recipients at our center between January 2010 and January 2017. We defined donor-based lung protective ventilation (dLPV) as 6 to 8 ml/kg of donor ideal body weight and plateau pressure <30 cm H₂O. We calculated the donor-recipient predicted total lung capacity (pTLC) ratio and used logistic regression to examine relationships between pTLC ratio, dLPV and PGD grade 3 at 48 to 72 hours. We used Cox proportional hazards modelling to examine the relationship between pTLC ratio, dLPV and 1-year survival.

Results

The cohort included 373 recipients; 24 (6.4%) developed PGD grade 3 at 48 to 72 hours, and 213 (57.3%) received dLPV. Mean pTLC ratio was 1.04 ± 0.18. dLPV was associated with significantly lower risks of PGD grade 3 (OR = 0.44; 95% CI: 0.29-0.68, p < 0.001) and 1-year mortality (HR = 0.49; 95% CI: 0.29-0.8, p = 0.018). There was a significant association between pTLC ratio and the risk of PGD grade 3, but this was attenuated by the use of dLPV.

Conclusions

dLPV is associated with decreased risk of PGD grade 3 at 48 to 72 hours and decreased 1-year mortality. Additionally, dLPV attenuates the association between pTLC and both PGD grade 3 and 1-year mortality. Donor-based ventilation strategies may help to mitigate the risk of PGD and other adverse outcomes associated with size mismatch after lung transplantation.

中文翻译：

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基于供体大小的肺保护性通气与肺移植后严重原发性移植物功能障碍的风险降低相关

背景

肺移植后立即进行机械通气可能会影响原发性移植物功能障碍 (PGD) 的发展，特别是在供受者大小不匹配的情况下，因为通气通常基于受者而不是供者大小。

方法

我们在 2010 年 1 月至 2017 年 1 月期间在我们中心对成人双侧肺移植受者进行了一项回顾性队列研究。我们将基于供体的肺保护性通气 (dLPV) 定义为 6 至 8 ml/kg 供体理想体重和平台压 <30 cm H ₂ O。我们计算了供体-受体预测的总肺活量(pTLC) 比率，并使用逻辑回归来检查 pTLC 比率、dLPV 和 48 至 72 小时 PGD 3 级之间的关系。我们使用 Cox 比例风险模型来检查 pTLC 比率、dLPV 和 1 年生存率之间的关系。

结果

该队列包括 373 名接受者；24 人 (6.4%) 在 48 至 72 小时内发展为 3 级 PGD，213 人 (57.3%) 接受了 dLPV。平均 pTLC 比率为 1.04 ± 0.18。dLPV 与 PGD 3 级（OR = 0.44；95% CI：0.29-0.68，p < 0.001）和 1 年死亡率（HR = 0.49；95% CI：0.29-0.8，p  = 0.018）的风险显着降低相关. pTLC 比率与 3 级 PGD 风险之间存在显着关联，但使用 dLPV 可减弱这种关联。

结论

dLPV 与 48 至 72 小时 PGD 3 级风险降低和 1 年死亡率降低相关。此外，dLPV 减弱了 pTLC 与 PGD 3 级和 1 年死亡率之间的关联。基于供体的通气策略可能有助于降低 PGD 的风险以及与肺移植后尺寸不匹配相关的其他不良后果。