1. Soluble P-Selectin and the Risk of Primary Graft Dysfunction After Lung Transplantation
- Author
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Daichi Shimbo, Joao A. de Andrade, Ejigayehu Demissie, Ashish S. Shah, Steven M. Kawut, Jason D. Christie, Aaron P. Milstone, Jeffrey M. Okun, Lorraine B. Ware, Vibha N. Lama, Ann Weinacker, and David J. Lederer
- Subjects
Adult ,Lung Diseases ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Primary Graft Dysfunction ,Critical Care and Intensive Care Medicine ,Gastroenterology ,Cohort Studies ,Reperfusion therapy ,Risk Factors ,Internal medicine ,Fraction of inspired oxygen ,medicine ,Humans ,Lung transplantation ,Platelet activation ,Risk factor ,Original Research ,Aged ,Lung ,business.industry ,Middle Aged ,respiratory system ,Platelet Activation ,Transplantation ,P-Selectin ,Logistic Models ,medicine.anatomical_structure ,Case-Control Studies ,Anesthesia ,Female ,Cardiology and Cardiovascular Medicine ,business ,Lung Transplantation - Abstract
Platelet activation with subsequent neutrophilic adherence to the vasculature initiates ischemia-reperfusion injury. We hypothesized that higher plasma P-selectin levels reflecting platelet activation would therefore be associated with primary graft dysfunction (PGD) after lung transplantation.In a prospective, multicenter cohort study of 376 patients who had undergone lung transplantation between 2002 and 2007, we measured soluble P-selectin levels before lung transplantation and at 6 and 24 h after lung reperfusion in 20 patients with grade III PGD (Pao(2)/fraction of inspired oxygen,200 mm Hg [with alveolar infiltrates seen on chest radiographs]) at 72 h after transplantation and 61 control subjects without PGD.Higher postoperative soluble P-selectin levels were associated with an increased risk of PGD at 72 h after transplantation (odds ratio [OR] per 1 natural log increase in soluble P-selectin at 6 h after lung allograft reperfusion, 3.5; 95% confidence interval [CI], 1.01 to 11.8; p = 0.048) and at 24 h after lung allograft reperfusion (OR, 4.8; 95% CI, 1.4 to 16.1; p = 0.01). Higher preoperative mean pulmonary artery pressure and the use of cardiopulmonary bypass were also associated with an increased risk of PGD.Higher postoperative soluble P-selectin levels were associated with an increased risk of PGD at 72 h following lung transplantation.
- Published
- 2009