BACKGROUND

Primary graft dysfunction (PGD) represents ischemia‒reperfusion injury in the lung allograft, and elevated left ventricular end-diastolic pressure (LVEDP) may contribute to capillary leak. We tested whether pre-transplant LVEDP or pulmonary capillary wedge pressure (mPCWP) are related to PGD risk. We hypothesized that elevated LVEDP and mPCWP would increase PGD risk.

METHODS

We reviewed adult double lung transplant recipients at the University of Alberta Hospital from 2004 to 2016 with pre-transplant LVEDP measurements. The primary outcome was Grade 3 PGD at 48 to 72 hours post-transplant. We used regression analysis to assess the association between LVEDP and mPCWP with Grade 3 PGD risk, as well as agreement between these measurements.

RESULTS

Three hundred thirty double lung transplant recipients were included in the study, and 63 (19%) developed Grade 3 PGD at 48 or 72 hours. Mean LVEDP was 16 ± 7 mm Hg in the Grade 3 PGD group and 12 ± 5 mm Hg in the non-PGD group (p < 0.0001). LVEDP >15 mm Hg was associated with an adjusted odds ratio (OR) of 3.83 (95% confidence interval [CI] 1.90 to 7.73, p < 0.0001), whereas mPCWP >15 mm Hg showed similar findings (adjusted OR 4.25 [1.83 to 9.86], p = 0.0008). Correlation and agreement between LVEDP and mPCWP were fair.

CONCLUSIONS

Elevated pre-transplant LVEDP increases the risk of severe PGD after lung transplant, as does elevated mPCWP. These measurements appear to be complementary as markers of prospective PGD risk.

中文翻译：

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双肺移植受者移植前左心室舒张末期压力升高会增加原发性移植物功能障碍的风险。

背景

原发性移植物功能障碍（PGD）表示同种异体肺缺血再灌注损伤，左心室舒张末期压力升高（LVEDP）可能导致毛细血管渗漏。我们测试了移植前LVEDP或肺毛细血管楔压（mPCWP）是否与PGD风险相关。我们假设升高的LVEDP和mPCWP会增加PGD风险。

方法

我们回顾了2004年至2016年阿尔伯塔大学医院成人双肺移植接受者的移植前LVEDP测量结果。主要结果是移植后48至72小时的3级PGD。我们使用回归分析来评估LVEDP和mPCWP与3级PGD风险之间的关联，以及这些测量之间的一致性。

结果

这项研究包括了330名双肺移植受者，其中63名（19％）在48或72小时出现了3级PGD。3级PGD组的平均LVEDP为16±7 mm Hg，非PGD组的平均LVEDP为12±5 mm Hg（p <0.0001）。LVEDP> 15 mm Hg与校正后的比值比（OR）为3.83（95％置信区间[CI] 1.90至7.73，p <0.0001）相关，而mPCWP> 15 mm Hg显示出相似的发现（校正后的OR为4.25 [1.83至0.95]。 9.86]，p  = 0.0008）。LVEDP和mPCWP之间的关联和协议是公平的。

结论

升高的移植前LVEDP和升高的mPCWP一样，会增加肺移植后发生严重PGD的风险。这些测量似乎是潜在的PGD风险的标志物的补充。