PT  - JOURNAL ARTICLE
AU  - Purificación Pérez-Terán
AU  - Oriol Roca
AU  - José Rodríguez-Palomares
AU  - Juan C. Ruiz-Rodríguez
AU  - Ana Zapatero
AU  - Joaquim Gea
AU  - Joaquim Serra
AU  - Arturo Evangelista
AU  - Joan R. Masclans
TI  - Prospective validation of right ventricular role in primary graft dysfunction after lung transplantation
AID  - 10.1183/13993003.02136-2015
DP  - 2016 Dec 01
TA  - European Respiratory Journal
PG  - 1732--1742
VI  - 48
IP  - 6
4099  - http://erj.ersjournals.com/content/48/6/1732.short
4100  - http://erj.ersjournals.com/content/48/6/1732.full
SO  - Eur Respir J2016 Dec 01; 48
AB  - Primary graft dysfunction is a significant cause of lung transplant morbidity and mortality, but its underlying mechanisms are not completely understood. The aims of the present study were: 1) to confirm that right ventricular function is a risk factor for severe primary graft dysfunction; and 2) to propose a clinical model for predicting the development of severe primary graft dysfunction.A prospective cohort study was performed over 14 months. The primary outcome was development of primary graft dysfunction grade 3. An echocardiogram was performed immediately before transplantation, measuring conventional and speckle-tracking parameters. Pulmonary artery catheter data were also measured. A classification and regression tree was made to identify prognostic models for the development of severe graft dysfunction.70 lung transplant recipients were included. Patients who developed severe primary graft dysfunction had better right ventricular function, as estimated by cardiac index (3.5±0.8 versus 2.6±0.7 L·min−1·m−2, p<0.01) and basal longitudinal strain (−25.7±7.3% versus −19.5±6.6%, p<0.01). Regression tree analysis provided an algorithm based on the combined use of three variables (basal longitudinal strain, pulmonary fibrosis disease and ischaemia time), allowing accurate preoperative discrimination of three distinct subgroups with low (11–20%), intermediate (54%) and high (75%) risk of severe primary graft dysfunction (area under the receiver operating characteristic curve 0.81).Better right ventricular function is a risk factor for the development of severe primary graft dysfunction. Preoperative estimation of right ventricular function could allow early identification of recipients at increased risk, who would benefit the most from careful perioperative management in order to limit pulmonary overflow.RV function assessment before LT by STE is essential for identification of recipients with higher risk of PGD http://ow.ly/fidz3036kpG