Early trends in Pao2/fraction of inspired oxygen ratio predict outcome in lung transplant recipients with severe primary graft dysfunction

Matthew E. Prekker, Cynthia S. Herrington, Marshall I. Hertz, David M. Radosevich, Peter S. Dahlberg

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Background: The development of severe primary graft dysfunction (PGD) is a risk factor for perioperative death following lung transplantation. Our goal is to improve the predictive value of the earliest PaO2/fraction of inspired oxygen (P/F) measurements that gauge PGD severity. Methods: We identified 96 patients with severe PGD (P/F < 200) at ICU arrival through a retrospective review of 431 lung transplants performed at our institution from 1992 to 2005. The P/F trend, represented as quartiles of the 12-h percentage change in P/F, was analyzed using multivariate logistic regression. Study outcomes were 90-day death and long-term survival. Results: The median percentage change in P/F over 12 h was + 52% (interquartile range, +20 to 90%). We observed the highest early mortality among those in the lowest quartile of the P/F trend (an increase in P/F ≤ 20%). Ninety-day death rates decreased across the quartiles (low quartile, 32%; low-mid quartile, 9%; high-mid quartile, 5%; high quartile, 5%; test for trend, p = 0.007). After adjustment for the use of cardiopulmonary bypass, those in the lowest quartile of P/F trend had 6.8 times the odds of early death vs patients with a more favorable trend (odds ratio, 6.80; 95% confidence interval, 1.73 to 0.51; p = 0.007). In the first 5 years after transplant, there were significantly more deaths within the low quartile group vs those with a more rapidly increasing P/F trend (log-rank test, p = 0.01). Conclusions: Among lung recipients with severe PGD at ICU arrival, an improvement in P/F ≤ 20% in the first 12 h portends a poor outcome.

Original languageEnglish (US)
Pages (from-to)991-997
Number of pages7
JournalCHEST
Volume132
Issue number3
DOIs
StatePublished - Sep 2007

Keywords

  • Acute lung injury
  • Lung transplantation
  • Reperfusion injury
  • Treatment outcome
  • Trends

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