• Steven M Kawut, Jeffrey Okun, Daichi Shimbo, David J Lederer, Joao De Andrade, Vibha Lama, Ashish Shah, Aaron Milstone, Lorraine B Ware, Ann Weinacker, Ejigayehu Demissie, Jason D Christie, and Lung Transplant Outcomes Group.
• Department of Medicine, Cardiovascular Institute, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. kawut@mail.med.upenn.edu
• Chest. 2009 Jul 1;136(1):237-44.

BackgroundPlatelet 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.MethodsIn 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 mm Hg [with alveolar infiltrates seen on chest radiographs]) at 72 h after transplantation and 61 control subjects without PGD.ResultsHigher 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.ConclusionHigher postoperative soluble P-selectin levels were associated with an increased risk of PGD at 72 h following lung transplantation.

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