Pulmonary hypertension is not a risk factor for grade 3 primary graft dysfunction after lung transplantation

Abstract

Grade 3 primary graft dysfunction (PGD3) represents the most important risk factor for patient mortality during the first year after lung transplantation (LTX). We investigated whether pretransplant pulmonary hypertension (PH) is a risk factor for the development of PGD3. This retrospective, single-center cohort study included 96 candidates undergoing right heart catheterization (RHC) prior to being listed for LTX between March 2000 and October 2015. Based on their mean pulmonary artery pressure (mPAP) levels, the patients were classified into 3 groups: (1) <25 mm Hg, (2) 25-34 mm Hg and (3) ≥35 mm Hg. Forty-seven patients were classified in group 1, 31 in group 2, and 18 in group 3. Fifteen recipients (16%, 95%-CI 8-23) developed PGD3. In the univariate analysis, the diagnosis of interstitial lung disease (ILD) compared to COPD (OR: 7.06, P = .005), blood transfusion >1000 mL during surgery (OR: 5.25, P = .005), the need for intra-operative cardio-pulmonary bypass (CPB) or extra-corporeal membrane oxygenation (ECMO) (OR: 4, P = .027), mPAP (OR 1.06, P = .007) and serum high density lipoprotein-cholesterol (HDL-C) (OR 0.09, P = .005) were associated with PGD3. In the multivariable logistic regression analysis, only HDL-C (OR 0.10, P = .016) was associated with PGD3 based on our single-center cohort data analysis.

Blood product transfusion and lung transplant outcomes: A systematic review

“…The limitations of the registry data are that they link the development of PGD to intraoperative pRBC but make no mention of other product subtypes. Interestingly, their findings are supported by Christie's analysis of the receptor for advanced glycation end products (RAGE), a molecule that is highly localized to the lung and was elevated in patients with PGD 34 . Ligands for this receptor, known as advanced glycation end products, are known to form in stored pRBC units.…”

“…Many of the studies that report transfusion requirements were investigating the impact of lung transplantation performed on MCS; from this group, blood transfusion volume of greater than 1 L was associated with the development of severe PGD. 5,34,40 The limitations of the registry data are that they link the development of PGD to intraoperative pRBC but make no mention of other product subtypes.…”

“…Interestingly, their findings are supported by Christie's analysis of the receptor for advanced glycation end products (RAGE), a molecule that is highly localized to the lung and was elevated in patients with PGD. 34 Ligands for this receptor, known as advanced glycation end products, are known to form in stored pRBC units. They thus theorize that ligands in the pRBC unit bind to RAGE in the fresh allograft, which then…”

“…Investigators from the Lung Transplant Outcomes Group (LTOG) have published compelling evidence that blood transfusion contributes to this problem. In three separate multicenter prospective studies from this group, blood transfusion volume of greater than 1 L was associated with the development of severe PGD 5,34,40 . The limitations of the registry data are that they link the development of PGD to intraoperative pRBC but make no mention of other product subtypes.…”

“…21,33 In nine studies, the primary endpoint was either PGD or risk factors for antibody development (Table 3). [34][35][36][37][38][39][40][41] Of the higher quality studies, three demonstrated an association between red blood cell transfusion (pRBC) and PGD, while two studies found that platelet transfusions were associated with the development of de novo donor specific antibodies (dnDSA) or HLA antibodies posttransplant. 5,34,37,40,41 Two of the remaining small studies assessed the impact of the aprotinin, an antifibrinolytic, on the incidence of PGD.…”