Quantitative Evidence for Revising the Definition of Primary Graft Dysfunction after Lung Transplant

dc.contributor.authorCantu, Edward
dc.contributor.authorDiamond, Joshua M.
dc.contributor.authorSuzuki, Yoshikazu
dc.contributor.authorLasky, Jared
dc.contributor.authorSchaufler, Christian
dc.contributor.authorLim, Brian
dc.contributor.authorShah, Rupal
dc.contributor.authorPorteous, Mary
dc.contributor.authorLederer, David J.
dc.contributor.authorKawut, Steven M.
dc.contributor.authorPalmer, Scott M.
dc.contributor.authorSnyder, Laurie D.
dc.contributor.authorHartwig, Matthew G.
dc.contributor.authorLama, Vibha N.
dc.contributor.authorBhorade, Sangeeta
dc.contributor.authorBermudez, Christian
dc.contributor.authorCrespo, Maria
dc.contributor.authorMcDyer, John
dc.contributor.authorWille, Keith
dc.contributor.authorOrens, Jonathan
dc.contributor.authorShah, Pali D.
dc.contributor.authorWeinacker, Ann
dc.contributor.authorWeill, David
dc.contributor.authorWilkes, David
dc.contributor.authorRoe, David
dc.contributor.authorHage, Chadi
dc.contributor.authorWare, Lorraine B.
dc.contributor.authorBellamy, Scarlett L.
dc.contributor.authorChristie, Jason D.
dc.contributor.departmentMedicine, School of Medicineen_US
dc.date.accessioned2019-07-02T20:21:38Z
dc.date.available2019-07-02T20:21:38Z
dc.date.issued2018-01-15
dc.description.abstractRATIONALE: Primary graft dysfunction (PGD) is a form of acute lung injury that occurs after lung transplantation. The definition of PGD was standardized in 2005. Since that time, clinical practice has evolved, and this definition is increasingly used as a primary endpoint for clinical trials; therefore, validation is warranted. OBJECTIVES: We sought to determine whether refinements to the 2005 consensus definition could further improve construct validity. METHODS: Data from the Lung Transplant Outcomes Group multicenter cohort were used to compare variations on the PGD definition, including alternate oxygenation thresholds, inclusion of additional severity groups, and effects of procedure type and mechanical ventilation. Convergent and divergent validity were compared for mortality prediction and concurrent lung injury biomarker discrimination. MEASUREMENTS AND MAIN RESULTS: A total of 1,179 subjects from 10 centers were enrolled from 2007 to 2012. Median length of follow-up was 4 years (interquartile range = 2.4-5.9). No mortality differences were noted between no PGD (grade 0) and mild PGD (grade 1). Significantly better mortality discrimination was evident for all definitions using later time points (48, 72, or 48-72 hours; P < 0.001). Biomarker divergent discrimination was superior when collapsing grades 0 and 1. Additional severity grades, use of mechanical ventilation, and transplant procedure type had minimal or no effect on mortality or biomarker discrimination. CONCLUSIONS: The PGD consensus definition can be simplified by combining lower PGD grades. Construct validity of grading was present regardless of transplant procedure type or use of mechanical ventilation. Additional severity categories had minimal impact on mortality or biomarker discrimination.en_US
dc.identifier.citationCantu, E., Diamond, J. M., Suzuki, Y., Lasky, J., Schaufler, C., Lim, B., … Lung Transplant Outcomes Group (2018). Quantitative Evidence for Revising the Definition of Primary Graft Dysfunction after Lung Transplant. American journal of respiratory and critical care medicine, 197(2), 235–243. doi:10.1164/rccm.201706-1140OCen_US
dc.identifier.urihttps://hdl.handle.net/1805/19821
dc.language.isoen_USen_US
dc.publisherAmerican Thoracic Societyen_US
dc.relation.isversionof10.1164/rccm.201706-1140OCen_US
dc.relation.journalAmerican Journal of Respiratory and Critical Care Medicineen_US
dc.rightsPublisher Policyen_US
dc.sourcePMCen_US
dc.subjectLung transplanten_US
dc.subjectLung transplant outcomesen_US
dc.subjectPrimary graft dysfunctionen_US
dc.titleQuantitative Evidence for Revising the Definition of Primary Graft Dysfunction after Lung Transplanten_US
dc.typeArticleen_US
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