Quantitative evidence for revising the definition of primary graft dysfunction after lung transplant

Edward Cantu, Joshua M. Diamond, Yoshikazu Suzuki, Jared Lasky, Christian Schaufler, Brian Lim, Rupal Shah, Mary Porteous, David J. Lederer, Steven M. Kawut, Scott M. Palmer, Laurie D. Snyder, Matthew G. Hartwig, Vibha N. Lama, Sangeeta Bhorade, Christian Bermudez, Maria Crespo, John McDyer, Keith Wille, Jonathan OrensPali D. Shah, Ann Weinacker, David Weill, David Wilkes, David Roe, Chadi Hage, Lorraine B. Ware, Scarlett L. Bellamy, Jason D. Christie

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Rationale: 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.

Original languageEnglish (US)
Pages (from-to)235-243
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume197
Issue number2
DOIs
StatePublished - Jan 15 2018

Fingerprint

Primary Graft Dysfunction
Transplants
Lung
Biomarkers
Artificial Respiration
Mortality
Lung Transplantation
Acute Lung Injury
Lung Injury
Clinical Trials

Keywords

  • Lung transplant
  • Lung transplant outcomes
  • Primary graft dysfunction

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Quantitative evidence for revising the definition of primary graft dysfunction after lung transplant. / Cantu, Edward; Diamond, Joshua M.; Suzuki, Yoshikazu; Lasky, Jared; Schaufler, Christian; Lim, Brian; Shah, Rupal; Porteous, Mary; Lederer, David J.; Kawut, Steven M.; Palmer, Scott M.; Snyder, Laurie D.; Hartwig, Matthew G.; Lama, Vibha N.; Bhorade, Sangeeta; Bermudez, Christian; Crespo, Maria; McDyer, John; Wille, Keith; Orens, Jonathan; Shah, Pali D.; Weinacker, Ann; Weill, David; Wilkes, David; Roe, David; Hage, Chadi; Ware, Lorraine B.; Bellamy, Scarlett L.; Christie, Jason D.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 197, No. 2, 15.01.2018, p. 235-243.

Research output: Contribution to journalArticle

Cantu, E, Diamond, JM, Suzuki, Y, Lasky, J, Schaufler, C, Lim, B, Shah, R, Porteous, M, Lederer, DJ, Kawut, SM, Palmer, SM, Snyder, LD, Hartwig, MG, Lama, VN, Bhorade, S, Bermudez, C, Crespo, M, McDyer, J, Wille, K, Orens, J, Shah, PD, Weinacker, A, Weill, D, Wilkes, D, Roe, D, Hage, C, Ware, LB, Bellamy, SL & Christie, JD 2018, 'Quantitative evidence for revising the definition of primary graft dysfunction after lung transplant', American Journal of Respiratory and Critical Care Medicine, vol. 197, no. 2, pp. 235-243. https://doi.org/10.1164/rccm.201706-1140OC
Cantu, Edward ; Diamond, Joshua M. ; Suzuki, Yoshikazu ; Lasky, Jared ; Schaufler, Christian ; Lim, Brian ; Shah, Rupal ; Porteous, Mary ; Lederer, David J. ; Kawut, Steven M. ; Palmer, Scott M. ; Snyder, Laurie D. ; Hartwig, Matthew G. ; Lama, Vibha N. ; Bhorade, Sangeeta ; Bermudez, Christian ; Crespo, Maria ; McDyer, John ; Wille, Keith ; Orens, Jonathan ; Shah, Pali D. ; Weinacker, Ann ; Weill, David ; Wilkes, David ; Roe, David ; Hage, Chadi ; Ware, Lorraine B. ; Bellamy, Scarlett L. ; Christie, Jason D. / Quantitative evidence for revising the definition of primary graft dysfunction after lung transplant. In: American Journal of Respiratory and Critical Care Medicine. 2018 ; Vol. 197, No. 2. pp. 235-243.
@article{1b49cc27606f4f818bf7aae9349ff740,
title = "Quantitative evidence for revising the definition of primary graft dysfunction after lung transplant",
abstract = "Rationale: 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.",
keywords = "Lung transplant, Lung transplant outcomes, Primary graft dysfunction",
author = "Edward Cantu and Diamond, {Joshua M.} and Yoshikazu Suzuki and Jared Lasky and Christian Schaufler and Brian Lim and Rupal Shah and Mary Porteous and Lederer, {David J.} and Kawut, {Steven M.} and Palmer, {Scott M.} and Snyder, {Laurie D.} and Hartwig, {Matthew G.} and Lama, {Vibha N.} and Sangeeta Bhorade and Christian Bermudez and Maria Crespo and John McDyer and Keith Wille and Jonathan Orens and Shah, {Pali D.} and Ann Weinacker and David Weill and David Wilkes and David Roe and Chadi Hage and Ware, {Lorraine B.} and Bellamy, {Scarlett L.} and Christie, {Jason D.}",
year = "2018",
month = "1",
day = "15",
doi = "10.1164/rccm.201706-1140OC",
language = "English (US)",
volume = "197",
pages = "235--243",
journal = "American Journal of Respiratory and Critical Care Medicine",
issn = "1073-449X",
publisher = "American Thoracic Society",
number = "2",

}

TY - JOUR

T1 - Quantitative evidence for revising the definition of primary graft dysfunction after lung transplant

AU - Cantu, Edward

AU - Diamond, Joshua M.

AU - Suzuki, Yoshikazu

AU - Lasky, Jared

AU - Schaufler, Christian

AU - Lim, Brian

AU - Shah, Rupal

AU - Porteous, Mary

AU - Lederer, David J.

AU - Kawut, Steven M.

AU - Palmer, Scott M.

AU - Snyder, Laurie D.

AU - Hartwig, Matthew G.

AU - Lama, Vibha N.

AU - Bhorade, Sangeeta

AU - Bermudez, Christian

AU - Crespo, Maria

AU - McDyer, John

AU - Wille, Keith

AU - Orens, Jonathan

AU - Shah, Pali D.

AU - Weinacker, Ann

AU - Weill, David

AU - Wilkes, David

AU - Roe, David

AU - Hage, Chadi

AU - Ware, Lorraine B.

AU - Bellamy, Scarlett L.

AU - Christie, Jason D.

PY - 2018/1/15

Y1 - 2018/1/15

N2 - Rationale: 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.

AB - Rationale: 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.

KW - Lung transplant

KW - Lung transplant outcomes

KW - Primary graft dysfunction

UR - http://www.scopus.com/inward/record.url?scp=85045220808&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85045220808&partnerID=8YFLogxK

U2 - 10.1164/rccm.201706-1140OC

DO - 10.1164/rccm.201706-1140OC

M3 - Article

C2 - 28872353

AN - SCOPUS:85045220808

VL - 197

SP - 235

EP - 243

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

IS - 2

ER -