1. Contemporary trends in PGD incidence, outcomes, and therapies
- Author
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Cantu, Edward, Diamond, Joshua M, Cevasco, Marisa, Suzuki, Yoshi, Crespo, Maria, Clausen, Emily, Dallara, Laura, Ramon, Christian V, Harmon, Michael T, Bermudez, Christian, Benvenuto, Luke, Anderson, Michaela, Wille, Keith M, Weinacker, Ann, Dhillon, Gundeep S, Orens, Jonathan, Shah, Pali, Merlo, Christian, Lama, Vibha, McDyer, John, Snyder, Laurie, Palmer, Scott, Hartwig, Matt, Hage, Chadi A, Singer, Jonathan, Calfee, Carolyn, Kukreja, Jasleen, Greenland, John R, Ware, Lorraine B, Localio, Russel, Hsu, Jesse, Gallop, Robert, and Christie, Jason D
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Organ Transplantation ,Lung ,Transplantation ,Clinical Research ,Good Health and Well Being ,Female ,Pregnancy ,Humans ,Primary Graft Dysfunction ,Incidence ,Preimplantation Diagnosis ,Prospective Studies ,Retrospective Studies ,Lung Transplantation ,primary graft dysfunction ,lung transplantation ,ECMO ,bridge to transplant ,outcomes and lung allocation score ,Cardiorespiratory Medicine and Haematology ,Surgery ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
BackgroundWe sought to describe trends in extracorporeal membrane oxygenation (ECMO) use, and define the impact on PGD incidence and early mortality in lung transplantation.MethodsPatients were enrolled from August 2011 to June 2018 at 10 transplant centers in the multi-center Lung Transplant Outcomes Group prospective cohort study. PGD was defined as Grade 3 at 48 or 72 hours, based on the 2016 PGD ISHLT guidelines. Logistic regression and survival models were used to contrast between group effects for event (i.e., PGD and Death) and time-to-event (i.e., death, extubation, discharge) outcomes respectively. Both modeling frameworks accommodate the inclusion of potential confounders.ResultsA total of 1,528 subjects were enrolled with a 25.7% incidence of PGD. Annual PGD incidence (14.3%-38.2%, p = .0002), median LAS (38.0-47.7 p = .009) and the use of ECMO salvage for PGD (5.7%-20.9%, p = .007) increased over the course of the study. PGD was associated with increased 1 year mortality (OR 1.7 [95% C.I. 1.2, 2.3], p = .0001). Bridging strategies were not associated with increased mortality compared to non-bridged patients (p = .66); however, salvage ECMO for PGD was significantly associated with increased mortality (OR 1.9 [1.3, 2.7], p = .0007). Restricted mean survival time comparison at 1-year demonstrated 84.1 days lost in venoarterial salvaged recipients with PGD when compared to those without PGD (ratio 1.3 [1.1, 1.5]) and 27.2 days for venovenous with PGD (ratio 1.1 [1.0, 1.4]).ConclusionsPGD incidence continues to rise in modern transplant practice paralleled by significant increases in recipient severity of illness. Bridging strategies have increased but did not affect PGD incidence or mortality. PGD remains highly associated with mortality and is increasingly treated with salvage ECMO.
- Published
- 2022