Journal
CHEST
Volume 136, Issue 1, Pages 237-244Publisher
AMER COLL CHEST PHYSICIANS
DOI: 10.1378/chest.08-2697
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Funding
- NHLBI NIH HHS [HL081332, R01 HL081619, U01 HL081332, K23 HL067771, L30 HL086095-02, HL081619, L30 HL086095-01, K23 HL067771-01, HL067771, K23 HL067771-03, K23 HL067771-04, R01 HL087115, L30 HL086095, K23 HL067771-02, K23 HL067771-06, K23 HL067771-05, HL04243, HL087115] Funding Source: Medline
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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 (Pao(2)/fraction of inspired oxygen, < 200 nun 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 I 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. (CHEST 2009; 136:237-244)
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