TY - JOUR
T1 - Impact of immediate primary lung allograft dysfunction on bronchiolitis obliterans syndrome
AU - Daud, Shiraz A.
AU - Yusen, Roger D.
AU - Meyers, Bryan F.
AU - Chakinala, Murali M.
AU - Walter, Michael J.
AU - Aloush, Aviva A.
AU - Patterson, G. Alexander
AU - Trulock, Elbert P.
AU - Hachem, Ramsey R.
PY - 2007/3/1
Y1 - 2007/3/1
N2 - Rationale: Primary graft dysfunction is a common complication after lung transplantation and a significant risk factor for short- and long-term mortality. Objective: We examined the impact of primary graft dysfunction on bronchiolitis obliterans syndrome. Methods: We performed a retrospective cohort study of 334 adult lung transplant recipients at our program and graded the severity of primary graft dysfunction according to the International Society for Heart and Lung Transplantation definition. We evaluated the impact of primary graft dysfunction on acute rejection, lymphocytic bronchitis, and bronchiolitis obliterans syndrome stage 1, using univariable and multivariable Cox proportional hazards models. Main Results: Among the 334 recipients, 65 did not have primary graft dysfunction (grade 0), 130 had grade 1, 69 had grade 2, and 70 had grade 3. In the univariable analysis, all grades of primary graft dysfunction were associated with a significantly increased risk of bronchiolitis obliterans syndrome stage 1 (grade 1: relative risk [RR] = 1.73; grade 2: RR = 2.13; and grade 3: RR = 2.53, compared with grade 0). The multivariable model demonstrated that the increased risk of bronchiolitis obliterans syndrome associated with primary graft dysfunction was independent of acute rejection, lymphocytic bronchitis, and community-acquired respiratory viral infections. However, there was no association between primary graft dysfunction and acute rejection or lymphocytic bronchitis. Conclusions: Primary graft dysfunction is associated with an increased risk of bronchiolitis obliterans syndrome independent of acute rejection, lymphocytic bronchitis, and community-acquired respiratory viral infections, and this risk is directly related to the severity of primary graft dysfunction.
AB - Rationale: Primary graft dysfunction is a common complication after lung transplantation and a significant risk factor for short- and long-term mortality. Objective: We examined the impact of primary graft dysfunction on bronchiolitis obliterans syndrome. Methods: We performed a retrospective cohort study of 334 adult lung transplant recipients at our program and graded the severity of primary graft dysfunction according to the International Society for Heart and Lung Transplantation definition. We evaluated the impact of primary graft dysfunction on acute rejection, lymphocytic bronchitis, and bronchiolitis obliterans syndrome stage 1, using univariable and multivariable Cox proportional hazards models. Main Results: Among the 334 recipients, 65 did not have primary graft dysfunction (grade 0), 130 had grade 1, 69 had grade 2, and 70 had grade 3. In the univariable analysis, all grades of primary graft dysfunction were associated with a significantly increased risk of bronchiolitis obliterans syndrome stage 1 (grade 1: relative risk [RR] = 1.73; grade 2: RR = 2.13; and grade 3: RR = 2.53, compared with grade 0). The multivariable model demonstrated that the increased risk of bronchiolitis obliterans syndrome associated with primary graft dysfunction was independent of acute rejection, lymphocytic bronchitis, and community-acquired respiratory viral infections. However, there was no association between primary graft dysfunction and acute rejection or lymphocytic bronchitis. Conclusions: Primary graft dysfunction is associated with an increased risk of bronchiolitis obliterans syndrome independent of acute rejection, lymphocytic bronchitis, and community-acquired respiratory viral infections, and this risk is directly related to the severity of primary graft dysfunction.
KW - Bronchiolitis obliterans syndrome
KW - Lung transplantation
KW - Primary graft dysfunction
UR - http://www.scopus.com/inward/record.url?scp=33847665250&partnerID=8YFLogxK
U2 - 10.1164/rccm.200608-1079OC
DO - 10.1164/rccm.200608-1079OC
M3 - Article
C2 - 17158279
AN - SCOPUS:33847665250
SN - 1073-449X
VL - 175
SP - 507
EP - 513
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 5
ER -