Recipient-Related Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation: A Systematic Review and Meta-Analysis

• Published in: PloS one Vol. 9; no. 3; p. e92773
• Main Authors: Liu, Yao, Liu, Yi, Su, Lili, Jiang, Shu-juan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21.03.2014; Public Library of Science (PLoS)
• Subjects: African Americans; Biology and Life Sciences; Blood & organ donations; Body mass; Cohort analysis; Coronary artery bypass; Cystic fibrosis; Female; Gender; Health aspects; Health risks; Heart surgery; Humans; Hypertension; Injury prevention; Ischemia; Laboratories; Lung diseases; Lung Diseases - diagnosis; Lung Diseases - therapy; Lung transplantation; Lung Transplantation - adverse effects; Lungs; Male; Medical research; Medicine; Medicine and Health Sciences; Meta-analysis; Morbidity; Mortality; Nitric oxide; Odds Ratio; Organ transplantation; Patient Outcome Assessment; Physical Sciences; Primary Graft Dysfunction - epidemiology; Primary Graft Dysfunction - etiology; Publication Bias; Pulmonary arteries; Pulmonary fibrosis; Pulmonary hypertension; Pulmonary Wedge Pressure; Reperfusion; Research and Analysis Methods; Risk analysis; Risk Factors; Sarcoidosis; Studies; Systematic review; Transplantation; Transplants & implants
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0092773

Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors. Herein, we carried out a systematic review and meta-analysis of published literature to identify recipient-related clinical risk factors associated with PGD development. A systematic search of electronic databases (PubMed, Embase, Web of Science, Cochrane CENTRAL, and Scopus) for studies published from 1970 to 2013 was performed. Cohort, case-control, or cross-sectional studies that examined recipient-related risk factors of PGD were included. The odds ratios (ORs) or mean differences (MDs) were calculated using random-effects models. Thirteen studies involving 10042 recipients met final inclusion criteria. From the pooled analyses, female gender (OR 1.38, 95% CI 1.09 to 1.75), African American (OR 1.82, 95%CI 1.36 to 2.45), idiopathic pulmonary fibrosis (IPF) (OR 1.78, 95% CI 1.49 to 2.13), sarcoidosis (OR 4.25, 95% CI 1.09 to 16.52), primary pulmonary hypertension (PPH) (OR 3.73, 95%CI 2.16 to 6.46), elevated BMI (BMI≥25 kg/m2) (OR 1.83, 95% CI 1.26 to 2.64), and use of cardiopulmonary bypass (CPB) (OR 2.29, 95%CI 1.43 to 3.65) were significantly associated with increased risk of PGD. Age, cystic fibrosis, secondary pulmonary hypertension (SPH), intra-operative inhaled nitric oxide (NO), or lung transplant type (single or bilateral) were not significantly associated with PGD development (all P>0.05). Moreover, a nearly 4 fold increased risk of short-term mortality was observed in patients with PGD (OR 3.95, 95% CI 2.80 to 5.57). Our analysis identified several recipient related risk factors for development of PGD. The identification of higher-risk recipients and further research into the underlying mechanisms may lead to selective therapies aimed at reducing this reperfusion injury.