Elevated pre-transplant left ventricular end-diastolic pressure increases primary graft dysfunction risk in double lung transplant recipients

J Heart Lung Transplant. 2019 Jul;38(7):710-718. doi: 10.1016/j.healun.2019.02.010. Epub 2019 Feb 18.

Abstract

Background: Primary graft dysfunction (PGD) represents ischemia‒reperfusion injury in the lung allograft, and elevated left ventricular end-diastolic pressure (LVEDP) may contribute to capillary leak. We tested whether pre-transplant LVEDP or pulmonary capillary wedge pressure (mPCWP) are related to PGD risk. We hypothesized that elevated LVEDP and mPCWP would increase PGD risk.

Methods: We reviewed adult double lung transplant recipients at the University of Alberta Hospital from 2004 to 2016 with pre-transplant LVEDP measurements. The primary outcome was Grade 3 PGD at 48 to 72 hours post-transplant. We used regression analysis to assess the association between LVEDP and mPCWP with Grade 3 PGD risk, as well as agreement between these measurements.

Results: Three hundred thirty double lung transplant recipients were included in the study, and 63 (19%) developed Grade 3 PGD at 48 or 72 hours. Mean LVEDP was 16 ± 7 mm Hg in the Grade 3 PGD group and 12 ± 5 mm Hg in the non-PGD group (p < 0.0001). LVEDP >15 mm Hg was associated with an adjusted odds ratio (OR) of 3.83 (95% confidence interval [CI] 1.90 to 7.73, p < 0.0001), whereas mPCWP >15 mm Hg showed similar findings (adjusted OR 4.25 [1.83 to 9.86], p = 0.0008). Correlation and agreement between LVEDP and mPCWP were fair.

Conclusions: Elevated pre-transplant LVEDP increases the risk of severe PGD after lung transplant, as does elevated mPCWP. These measurements appear to be complementary as markers of prospective PGD risk.

Keywords: diastolic dysfunction; heart failure; heart failure with preserved ejection fraction; left ventricular end diastolic pressure; lung transplantation; primary graft dysfunction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Pressure*
  • Female
  • Heart Ventricles / physiopathology*
  • Humans
  • Lung Diseases / physiopathology*
  • Lung Diseases / surgery*
  • Lung Transplantation* / methods
  • Male
  • Middle Aged
  • Preoperative Period
  • Primary Graft Dysfunction / epidemiology*
  • Primary Graft Dysfunction / etiology
  • Pulmonary Wedge Pressure*
  • Retrospective Studies
  • Risk Assessment
  • Time Factors
  • Treatment Outcome