Cargando…

Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation

Since candidates with comorbidities are increasingly referred for lung transplantation, knowledge about comorbidities and their cumulative effect on outcomes is scarce. We retrospectively collected pretransplant comorbidities of all 513 adult recipients transplanted at our center between 1992–2019....

Descripción completa

Detalles Bibliográficos
Autores principales: Ehrsam, Jonas Peter, Schuurmans, Macé M., Laager, Mirjam, Opitz, Isabelle, Inci, Ilhan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9276940/
https://www.ncbi.nlm.nih.gov/pubmed/35845547
http://dx.doi.org/10.3389/ti.2022.10451
_version_ 1784745830118326272
author Ehrsam, Jonas Peter
Schuurmans, Macé M.
Laager, Mirjam
Opitz, Isabelle
Inci, Ilhan
author_facet Ehrsam, Jonas Peter
Schuurmans, Macé M.
Laager, Mirjam
Opitz, Isabelle
Inci, Ilhan
author_sort Ehrsam, Jonas Peter
collection PubMed
description Since candidates with comorbidities are increasingly referred for lung transplantation, knowledge about comorbidities and their cumulative effect on outcomes is scarce. We retrospectively collected pretransplant comorbidities of all 513 adult recipients transplanted at our center between 1992–2019. Multiple logistic- and Cox regression models, adjusted for donor-, pre- and peri-operative variables, were used to detect independent risk factors for primary graft dysfunction grade-3 at 72 h (PGD3-T72), onset of chronic allograft dysfunction grade-3 (CLAD-3) and survival. An increasing comorbidity burden measured by Charleston-Deyo-Index was a multivariable risk for survival and PGD3-T72, but not for CLAD-3. Among comorbidities, congestive right heart failure or a mean pulmonary artery pressure >25 mmHg were independent risk factors for PGD3-T72 and survival, and a borderline risk for CLAD-3. Left heart failure, chronic atrial fibrillation, arterial hypertension, moderate liver disease, peptic ulcer disease, gastroesophageal reflux, diabetes with end organ damage, moderate to severe renal disease, osteoporosis, and diverticulosis were also independent risk factors for survival. For PGD3-T72, a BMI>30 kg/m2 was an additional independent risk. Epilepsy and a smoking history of the recipient of >20packyears are additional independent risk factors for CLAD-3. The comorbidity profile should therefore be closely considered for further clinical decision making in candidate selection.
format Online
Article
Text
id pubmed-9276940
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-92769402022-07-14 Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation Ehrsam, Jonas Peter Schuurmans, Macé M. Laager, Mirjam Opitz, Isabelle Inci, Ilhan Transpl Int Health Archive Since candidates with comorbidities are increasingly referred for lung transplantation, knowledge about comorbidities and their cumulative effect on outcomes is scarce. We retrospectively collected pretransplant comorbidities of all 513 adult recipients transplanted at our center between 1992–2019. Multiple logistic- and Cox regression models, adjusted for donor-, pre- and peri-operative variables, were used to detect independent risk factors for primary graft dysfunction grade-3 at 72 h (PGD3-T72), onset of chronic allograft dysfunction grade-3 (CLAD-3) and survival. An increasing comorbidity burden measured by Charleston-Deyo-Index was a multivariable risk for survival and PGD3-T72, but not for CLAD-3. Among comorbidities, congestive right heart failure or a mean pulmonary artery pressure >25 mmHg were independent risk factors for PGD3-T72 and survival, and a borderline risk for CLAD-3. Left heart failure, chronic atrial fibrillation, arterial hypertension, moderate liver disease, peptic ulcer disease, gastroesophageal reflux, diabetes with end organ damage, moderate to severe renal disease, osteoporosis, and diverticulosis were also independent risk factors for survival. For PGD3-T72, a BMI>30 kg/m2 was an additional independent risk. Epilepsy and a smoking history of the recipient of >20packyears are additional independent risk factors for CLAD-3. The comorbidity profile should therefore be closely considered for further clinical decision making in candidate selection. Frontiers Media S.A. 2022-06-29 /pmc/articles/PMC9276940/ /pubmed/35845547 http://dx.doi.org/10.3389/ti.2022.10451 Text en Copyright © 2022 Ehrsam, Schuurmans, Laager, Opitz and Inci. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Health Archive
Ehrsam, Jonas Peter
Schuurmans, Macé M.
Laager, Mirjam
Opitz, Isabelle
Inci, Ilhan
Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation
title Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation
title_full Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation
title_fullStr Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation
title_full_unstemmed Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation
title_short Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation
title_sort recipient comorbidities for prediction of primary graft dysfunction, chronic allograft dysfunction and survival after lung transplantation
topic Health Archive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9276940/
https://www.ncbi.nlm.nih.gov/pubmed/35845547
http://dx.doi.org/10.3389/ti.2022.10451
work_keys_str_mv AT ehrsamjonaspeter recipientcomorbiditiesforpredictionofprimarygraftdysfunctionchronicallograftdysfunctionandsurvivalafterlungtransplantation
AT schuurmansmacem recipientcomorbiditiesforpredictionofprimarygraftdysfunctionchronicallograftdysfunctionandsurvivalafterlungtransplantation
AT laagermirjam recipientcomorbiditiesforpredictionofprimarygraftdysfunctionchronicallograftdysfunctionandsurvivalafterlungtransplantation
AT opitzisabelle recipientcomorbiditiesforpredictionofprimarygraftdysfunctionchronicallograftdysfunctionandsurvivalafterlungtransplantation
AT inciilhan recipientcomorbiditiesforpredictionofprimarygraftdysfunctionchronicallograftdysfunctionandsurvivalafterlungtransplantation