PDF(Pubmed)
Abstract：
UNASSIGNED: Primary graft dysfunction (PGD) is the most important determinant of morbidity and mortality after lung transplantation, but its definition has evolved over the past decade. The implications of this refinement in clinical definition have not been evaluated. In this single-center study, we compared PGD incidence, risk factors, and outcomes using the 2005 and the updated-2016 International Society of Heart and Lung Transplantation guidelines for PGD grading in lung transplant patients.
UNASSIGNED: In this retrospective study, we extracted data from the medical records of 127 patients who underwent lung transplantation between 1/1/2016-12/31/2018. PGD was defined as PGD3 present at 48 and/or 72 hours post-reperfusion. We used the 2005 and the updated 2016 guidelines to assess clinical risk factors, outcomes, and baseline biomarkers for PGD.
UNASSIGNED: On the basis of the 2016 and 2005 guidelines, we identified PGD in 37% and 26% of patients, respectively. PGD was significantly associated with extracorporeal life support, large body mass index, and restrictive lung disease using the 2016 but not the 2005 guidelines. Based on the 2016 guidelines, pretransplant levels of several biomarkers were associated with PGD; using the 2005 guidelines, only increased interleukin-2 levels were significantly associated with PGD. No preoperative biomarkers were associated with PGD using either guidelines after adjusting for clinical variables. Postoperative morbidity and 1-year mortality were similar regardless of guidelines used.
UNASSIGNED: Our findings suggest that refinements in the PGD scoring system have improved the detection of graft injury and associated risk factors without changing its ability to predict postoperative morbidity and mortality.
UNASSIGNED: In this retrospective study, we extracted data from the medical records of 127 patients who underwent lung transplantation between 1/1/2016-12/31/2018. PGD was defined as PGD3 present at 48 and/or 72 hours post-reperfusion. We used the 2005 and the updated 2016 guidelines to assess clinical risk factors, outcomes, and baseline biomarkers for PGD.
UNASSIGNED: On the basis of the 2016 and 2005 guidelines, we identified PGD in 37% and 26% of patients, respectively. PGD was significantly associated with extracorporeal life support, large body mass index, and restrictive lung disease using the 2016 but not the 2005 guidelines. Based on the 2016 guidelines, pretransplant levels of several biomarkers were associated with PGD; using the 2005 guidelines, only increased interleukin-2 levels were significantly associated with PGD. No preoperative biomarkers were associated with PGD using either guidelines after adjusting for clinical variables. Postoperative morbidity and 1-year mortality were similar regardless of guidelines used.
UNASSIGNED: Our findings suggest that refinements in the PGD scoring system have improved the detection of graft injury and associated risk factors without changing its ability to predict postoperative morbidity and mortality.
摘要：
■原发性移植物功能障碍（PGD）是肺移植后发病率和死亡率的最重要决定因素，但是它的定义在过去的十年中有所发展。尚未评估这种改进在临床定义中的含义。在这项单中心研究中，我们比较了PGD发生率,危险因素，使用2005年和2016年国际心肺移植学会指南对肺移植患者进行PGD分级。
■在这项回顾性研究中，我们从2016年1月1日至2018年12月31日接受肺移植的127例患者的病历中提取数据.PGD定义为在再灌注后48和/或72小时存在的PGD3。我们使用2005年和2016年更新的指南来评估临床风险因素，结果，和PGD的基线生物标志物。
■根据2016年和2005年指南，我们在37%和26%的患者中发现了PGD，分别。PGD与体外生命支持显着相关，大体重指数，和限制性肺病使用2016年而不是2005年的指南。根据2016年的指导方针，移植前几种生物标志物的水平与PGD相关；使用2005年指南，只有白细胞介素-2水平升高与PGD显著相关.在调整临床变量后，使用任一指南均未发现术前生物标志物与PGD相关。无论使用何种指南，术后发病率和1年死亡率相似。
■我们的发现表明，PGD评分系统的改进改善了对移植物损伤和相关危险因素的检测，而不改变其预测术后发病率和死亡率的能力。
■在这项回顾性研究中，我们从2016年1月1日至2018年12月31日接受肺移植的127例患者的病历中提取数据.PGD定义为在再灌注后48和/或72小时存在的PGD3。我们使用2005年和2016年更新的指南来评估临床风险因素，结果，和PGD的基线生物标志物。
■根据2016年和2005年指南，我们在37%和26%的患者中发现了PGD，分别。PGD与体外生命支持显着相关，大体重指数，和限制性肺病使用2016年而不是2005年的指南。根据2016年的指导方针，移植前几种生物标志物的水平与PGD相关；使用2005年指南，只有白细胞介素-2水平升高与PGD显著相关.在调整临床变量后，使用任一指南均未发现术前生物标志物与PGD相关。无论使用何种指南，术后发病率和1年死亡率相似。
■我们的发现表明，PGD评分系统的改进改善了对移植物损伤和相关危险因素的检测，而不改变其预测术后发病率和死亡率的能力。
