与肺移植后原发性移植物功能障碍相关的供体和受体因素:DMG 登记分析。

IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Thoracic and Cardiovascular Surgery Pub Date : 2024-11-01 DOI:10.1016/j.jtcvs.2024.10.045
Isaac S Alderete, Cathlyn K Medina, Arya Pontula, Samantha E Halpern, Alexandria L Soto, Kunal J Patel, Jacob A Klapper, Matthew G Hartwig
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引用次数: 0

摘要

目的:目前用于预测肺移植(LTx)后原发性移植物功能障碍(PGD)的风险调整模型不包括床旁供体重症监护数据。供体管理目标(DMG)是预先确定的重症监护终点,旨在优化多器官供体管理。在此,我们试图找出新的预测因素,以更好地了解LTx后供体管理与PGD之间的关系:我们利用全国 DMG 登记册确定了 2015 年 1 月 1 日至 2023 年 3 月 1 日期间与各自供体相关联的 LTx 受体队列。3级PGD(PGD3)是根据修改后的ISHLT标准定义的。结果显示,共有 2704 名符合条件的患者出现了 3 级 PGD(PGD3):结果:共确定了 2704 名符合条件的患者,其中 643 人(23.8%)出现了 PGD3。经多变量建模后,供体年龄增加(每 5 年变化 OR 1.06 [1.02, 1.10],P=0.003)、授权时供体血清 pH 值增加(OR 1.14 [1.02, 1.25] per 0.1 increase, p=0.016)、供体有可卡因使用史(OR 1.34 [1.05, 1.71],p=0.020)和受体中心静脉压升高(1.03 [1.01, 1.06],p=0.005)。接受符合DMG与PF比值的供肺的受者发生PGD3的可能性较低(OR 0.63 [0.46,0.86],P=0.006):本研究利用新颖、详细的捐献者管理数据库来识别与 PGD3 发生相关的因素。这些因素可用于识别可能受益于早期干预以改善短期结果的供体和受体。
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Donor and Recipient Factors Associated with Primary Graft Dysfunction Following Lung Transplantation: A DMG Registry Analysis.

Objective: Current risk-adjusted models to predict primary graft dysfunction (PGD) following lung transplantation (LTx) do not include bedside donor critical care data. Donor management goals (DMG) represent predefined critical care endpoints aimed at optimizing multi-organ donor management. Here, we sought to identify novel predictors to better understand the relationship between donor management and PGD following LTx.

Methods: We used the national DMG registry to identify a cohort of LTx recipients linked to their respective donors between January 1st, 2015 and March 1st, 2023. Grade 3 PGD (PGD3) was defined according to modified ISHLT criteria. Multivariable modeling was performed to identify risk factors for the development of PGD3.

Results: A total of 2704 eligible patients were identified of which 643 (23.8%) developed PGD3. After multivariable modeling, the likelihood of PGD3 was greater with increased donor age (OR 1.06 [1.02, 1.10] per 5 year change, p=0.003), increased donor serum pH at the time of authorization (OR 1.14 [1.02, 1.25] per 0.1 increase, p=0.016), donor history of cocaine use (OR 1.34 [1.05, 1.71], p=0.020), and increased recipient central venous pressure (1.03 [1.01, 1.06], p=0.005). Recipients who received donor lungs in which the DMG for PF ratio was met had a lower likelihood of developing PGD3 (OR 0.63 [0.46, 0.86], p=0.006).

Conclusion: This study leverages a novel detailed donor management database to identify factors associated with the development of PGD3. These factors may be used to recognize donors and recipients that may benefit from early interventions to improve short-term outcomes.

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来源期刊
CiteScore
11.20
自引率
10.00%
发文量
1079
审稿时长
68 days
期刊介绍: The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.
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