Early Trends in PaO 2 /Fraction of Inspired Oxygen Ratio Predict Outcome in Lung Transplant Recipients With Severe Primary Graft Dysfunction

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

doi:10.1378/chest.06-2752

Cited by 28 publications

(25 citation statements)

References 17 publications

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“…First, we did not perform grading at the T0 time point 15,27,28. The lack of earlier time points may have hampered our ability to demonstrate differences in PGD grade with mortality by different transplant procedure types 8.…”

Section: Discussionmentioning

confidence: 99%

Construct validity of the definition of primary graft dysfunction after lung transplantation

Christie

Bellamy

Ware

et al. 2010

The Journal of Heart and Lung Transplantation

139

122

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Section: Discussionmentioning

confidence: 99%

Construct validity of the definition of primary graft dysfunction after lung transplantation

Christie

Bellamy

Ware

et al. 2010

The Journal of Heart and Lung Transplantation

139

122

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“…Use of CPB could explain the effects of estradiol seen in our cohort since CPB has been associated with the development of PGD in other studies. (5, 15, 17, 37) [JB1] Although in our study there was an association between CPB and the development of PGD in univariate analysis, 24-hour postoperative estradiol levels were still associated with the development of PGD when controlling for CPB in the multivariable analysis. There was no difference in the percentage of male and female patients who were placed on CPB during transplantation.…”

Section: Discussionmentioning

confidence: 72%

Postoperative Estradiol Levels Associate With Development of Primary Graft Dysfunction in Lung Transplantation Patients

et al. 2012

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Primary graft dysfunction (PGD) frequently complicates lung transplantation in the immediate postoperative period. Both female gender and estradiol modulate the body’s response to injury and may influence the rate of alveolar fluid clearance. We hypothesized that female gender and higher estradiol levels would be associated with a lower risk of PGD after lung transplantation. We measured plasma estradiol levels pre-operatively, 6 hours postoperatively and 24 hours postoperatively in a cohort of 111 lung transplant recipients at two institutions. The mean age was 57 years (+/− 12.5) and 52% were female. The median postoperative estradiol level was 63.9 pg/ml (IQR 28.8–154.3) in men and 65.1 pg/ml (IQR 28.4–217.2) in females. Contrary to our hypothesis, higher estradiol levels at 24 hours were associated with an increased risk of PGD at 72 hours in males (p=0.001). This association was preserved when accounting for other factors known to be associated with PGD. However, there was no relationship between gender and risk of PGD or between estradiol levels and PGD in females. These findings suggest that there may be different biologic effects of estrogens in males and females and highlight the importance of considering gender differences in future studies of PGD.

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“…This is a common metric of choice for describing the severity of hypoxemic respiratory failure in the ICU literature and has previously been used in HPS 10, 17. We defined a response to therapy as a change in PF ratio of ≥20%, based on 3 factors: (1) this is an accepted threshold for minimal clinically relevant change 18, 19; (2) smaller percentage changes could result from simple fluctuations in PaO 2 , given baseline PaO 2 's of <65–70 mmHg (corresponding to a saturation of <85%) in patients entering the algorithm 20; and (3) the previously reported top range for mean coefficient of variation for PaO 2 is 10–11% over a 1‐h period in medically stable ICU patients, whereby a 20% change approximates the variation expected by 2 standard deviations (as a proportion of baseline value) 21.…”

Section: Resultsmentioning

confidence: 99%

Proposed Management Algorithm for Severe Hypoxemia After Liver Transplantation in the Hepatopulmonary Syndrome

Nayyar

Man

Granton

et al. 2015

American Journal of Transplantation

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The hepatopulmonary syndrome (HPS) is defined as the triad of liver disease, intrapulmonary vascular dilatation, and abnormal gas exchange, and is found in 10–32% of patients with liver disease. Liver transplantation is the only known cure for HPS, but patients can develop severe posttransplant hypoxemia, defined as a need for 100% inspired oxygen to maintain a saturation of ≥85%. This complication is seen in 6–21% of patients and carries a 45% mortality. Its management requires the application of specific strategies targeting the underlying physiologic abnormalities in HPS, but awareness of these strategies and knowledge on their optimal use is limited. We reviewed existing literature to identify strategies that can be used for this complication, and developed a clinical management algorithm based on best evidence and expert opinion. Evidence was limited to case reports and case series, and we determined which treatments to include in the algorithm and their recommended sequence based on their relative likelihood of success, invasiveness, and risk. Recommended therapies include: Trendelenburg positioning, inhaled epoprostenol or nitric oxide, methylene blue, embolization of abnormal pulmonary vessels, and extracorporeal life support. Availability and use of this pragmatic algorithm may improve management of this complication, and will benefit from prospective validation.

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Early Trends in PaO 2 /Fraction of Inspired Oxygen Ratio Predict Outcome in Lung Transplant Recipients With Severe Primary Graft Dysfunction

Cited by 28 publications

References 17 publications

Construct validity of the definition of primary graft dysfunction after lung transplantation

Construct validity of the definition of primary graft dysfunction after lung transplantation

Postoperative Estradiol Levels Associate With Development of Primary Graft Dysfunction in Lung Transplantation Patients

Proposed Management Algorithm for Severe Hypoxemia After Liver Transplantation in the Hepatopulmonary Syndrome

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