2009 Articles

Soluble P-Selectin and the Risk of Primary Graft Dysfunction After Lung Transplantation

Kawut, Steven M.; Okun, Jeffrey; Shimbo, Daichi; Lederer, David J.; De Andrade, Joao; Lama, Vibha; Shah, Ashish; Milstone, Aaron; Ware, Lorraine B.; Weinacker, Ann; Demissie, Ejigayehu; Christie, Jason D.; Lung Transplant Outcomes Group

Background - Platelet activation with subsequent neutrophilic adherence to the vasculature initiates ischemia-reperfusion injury. We hypothesized that higher plasma P-selectin levels reflecting platelet activation would therefore be associated with primary graft dysfunction (PGD) after lung transplantation.

Methods - In a prospective, multicenter cohort study of 376 patients who had undergone lung transplantation between 2002 and 2007, we measured soluble P-selectin levels before lung transplantation and at 6 and 24 h after lung reperfusion in 20 patients with grade III PGD (Pao2/fraction of inspired oxygen, < 200 mm Hg [with alveolar infiltrates seen on chest radiographs]) at 72 h after transplantation and 61 control subjects without PGD.

Results - Higher postoperative soluble P-selectin levels were associated with an increased risk of PGD at 72 h after transplantation (odds ratio [OR] per 1 natural log increase in soluble P-selectin at 6 h after lung allograft reperfusion, 3.5; 95% confidence interval [CI], 1.01 to 11.8; p = 0.048) and at 24 h after lung allograft reperfusion (OR, 4.8; 95% CI, 1.4 to 16.1; p = 0.01). Higher preoperative mean pulmonary artery pressure and the use of cardiopulmonary bypass were also associated with an increased risk of PGD.

Conclusion - Higher postoperative soluble P-selectin levels were associated with an increased risk of PGD at 72 h following lung transplantation.