TABLE 3.
Unadjusted analysis.
| Unadjusted analysis for risk factors associated with clinically significant airway ischemia | |||||
|---|---|---|---|---|---|
| CSAI (N = 126) | Non-CSAI (N = 260) | p-value | OR | CI | |
| Patient Demographics | |||||
| Age (years) | 51.30 (15.86) | 53.29 (15.31) | 0.24 | 0.99 | 0.98, 1.01 |
| Gender | |||||
| Female | 52 (41.3%) | 105 (40.4%) | |||
| Male | 74 (58.7%) | 155 (59.6%) | 0.87 | 0.96 | 0.63, 1.49 |
| Body-Mass Index | 25.36 (5.71) | 25.39 (5.41) | 0.96 | 1 | 0.96, 1.04 |
| Type of Transplant | |||||
| Single | 15 (11.9%) | 33 (12.7%) | |||
| Double | 111 (88.1%) | 227 (87.3%) | 0.83 | 1.08 | 0.57, 2.11 |
| First Anastomosis | |||||
| Left | 61 (48.4%) | 103 (39.6%) | |||
| Right | 65 (51.6%) | 157 (60.4%) | 0.1 | 0.7 | 0.45, 1.07 |
| Primary Diagnosis | |||||
| ILD/Restrictive Lung Disease | 68 (54%) | 152 (58.5%) | |||
| COPD | 23 (18.3%) | 42 (16.2%) | 0.5 | 0.82 | 0.46, 1.48 |
| Cystic Fibrosis | 25 (19.8%) | 47 (18.1%) | 0.38 | 1.83 | 0.46, 7.21 |
| PAH/PVD | 5 (4%) | 5 (1.9%) | 0.94 | 0.97 | 0.48, 1.97 |
| Other | 5 (4%) | 14 (5.4%) | 0.46 | 0.65 | 0.19, 1.95 |
| Multiorgan Transplant | 4 (3.2%) | 7 (2.7%) | 0.79 | 1.19 | 0.31, 4.00 |
| LAS score | 43.10 (11.53) | 45.79 (15.65) | 0.09 | 0.99 | 0.97, 1.00 |
| ABO Type | |||||
| A | 46 (36.5%) | 97 (37.3%) | |||
| B | 12 (9.5%) | 26 (10%) | 0.95 | 0.97 | 0.44, 2.07 |
| O | 61 (48.4%) | 122 (46.9%) | 0.82 | 1.05 | 0.66, 1.69 |
| AB | 7 (5.6%) | 15 (5.8%) | 0.97 | 0.98 | 0.36, 2.51 |
| Condition at Transplant | |||||
| Hospitalized | 4 (3.2%) | 8 (3.1%) | |||
| ICU | 8 (6.3%) | 31 (11.9%) | 0.37 | 0.52 | 0.13, 2.32 |
| Not hospitalized | 114 (90.5%) | 221 (85%) | 0.96 | 1.03 | 0.32, 3.93 |
| Life support prior to transplant | 5 (4%) | 28 (10.8%) | 0.03 | 0.34 | 0.11, 0.84 |
| Preoperative Ventilator Use | 0 (0%) | 4 (1.5%) | 0.98 | 0 | NA, 5.68E+29 |
| Preoperative ECMO | 2 (1.6%) | 10 (3.8%) | 0.22 | 0.38 | 0.06, 1.48 |
| Preoperative Noninvasive Ventilation | 3 (2.4%) | 14 (5.4%) | 0.17 | 0.41 | 0.09, 1.29 |
| Mean PAP (mmHg) | 26 (9.44) | 26.80 (9.87) | 0.71 | 1 | 0.97, 1.02 |
| Creatinine (mg/dL) | 0.86 (0.20) | 0.86 (0.45) | 0.93 | 0.97 | 0.50, 1.67 |
| Prior cardiac surgery | 0 (0%) | 9 (3.5%) | 0.98 | 0 | NA, 1.23E+21 |
| Prior lung surgery | 23 (18.3%) | 39 (15%) | 0.42 | 1.27 | 0.71, 2.21 |
| Type 2 diabetes mellitus | 39 (31%) | 55 (21.2%) | 0.04 | 1.67 | 1.03, 2.70 |
| History of Smoking | 64 (50.8%) | 134 (51.5%) | 0.89 | 0.97 | 0.63, 1.49 |
| Re-Transplant | 1 (0.8%) | 9 (3.5%) | 0.16 | 0.22 | 0.01, 1.21 |
| Chronic steroid use | 46 (36.5%) | 111 (42.7%) | 0.25 | 0.77 | 0.50, 1.19 |
| Donor Characteristics | |||||
| Donor Type | |||||
| DBD | 120 (95.2%) | 241 (92.7%) | |||
| DCD | 6 (4.8%) | 19 (7.3%) | 0.34 | 0.63 | 0.23, 1.54 |
| Age (years) | 36.16 (12.69) | 35.07 (12.75) | 0.43 | 1.01 | 0.99, 1.02 |
| Gender | |||||
| Female | 54 (42.9%) | 86 (33.1%) | |||
| Male | 72 (57.1%) | 174 (66.9%) | 0.06 | 0.66 | 0.43, 1.02 |
| Diabetes | 16 (12.7%) | 24 (9.2%) | 0.3 | 1.42 | 0.72, 2.77 |
| >20 py smoking history | 78 (61.9%) | 139 (53.5%) | 0.13 | 1.4 | 0.91, 2.18 |
| Extended Criteria Donor a | 55 (43.7%) | 102 (39.2%) | 0.41 | 1.2 | 0.78, 1.85 |
| Donor Cultures | |||||
| Candida species | 41 (32.5%) | 66 (25.4%) | 0.10 | 1.49 | 0.93, 2.38 |
| Any positive donor cultures | 101 (80.2%) | 202 (77.7%) | 0.24 | 1.40 | 0.81, 2.51 |
| Perioperative Characteristics | |||||
| ECLS | |||||
| Off-Pump | 20 (15.9%) | 63 (24.2%) | |||
| ECMO | 35 (27.8%) | 57 (21.9%) | 0.05 | 1.93 | 1.01, 3.77 |
| CPB | 71 (56.3%) | 140 (53.8%) | 0.11 | 1.6 | 0.91, 2.90 |
| EVLP | 28 (22.2%) | 42 (16.2%) | 0.15 | 1.48 | 0.86, 2.52 |
| Total Ischemic Time (min) | 330.00 (153.93) | 320.95 (132.66) | 0.55 | 1 | 1.00, 1.00 |
| Warm Ischemic Time (min) | 42.72 (14.84) | 45.20 (13.00) | 0.19 | 0.99 | 0.96, 1.01 |
| Suture Technique | |||||
| Running | 100 (79.4%) | 171 (65.8%) | |||
| Interrupted | 26 (20.6%) | 89 (34.2%) | 0.01 | 0.5 | 0.30, 0.82 |
| PGD 3 at 48–72 h | 28 (22.2%) | 57 (21.9%) | 0.95 | 1.02 | 0.60, 1.69 |
| Post-Op ECMO | 18 (14.3%) | 33 (12.7%) | 0.67 | 1.15 | 0.61, 2.11 |
| Ventilator Support >5 days | 40 (31.7%) | 76 (29.2%) | 0.61 | 1.13 | 0.71, 1.78 |
| Peak mixed venous O2 within 48 h | 72.46 (11.55) | 76.00 (10.02) | 0.01 | 0.97 | 0.95, 0.99 |
| Peak Creatinine within 48 h | 1.02 (0.34) | 1.04 (0.50) | 0.61 | 0.88 | 0.53, 1.41 |
| Peak Lactate within 72 h | 7.10 (3.62) | 6.96 (3.72) | 0.73 | 1.01 | 0.95, 1.07 |
| Atrial Fibrillation | 56 (44.4%) | 110 (42.3%) | 0.69 | 1.09 | 0.71, 1.67 |
| Major Bleeding b | 21 (16.7%) | 19 (7.3%) | 0.01 | 2.54 | 1.31, 4.95 |
| Acute Cellular Rejection | 14 (11.1%) | 16 (6.2%) | 0.09 | 1.9 | 0.88, 4.03 |
Continuous variables expressed as Mean (SD); Categorical variables expressed as frequency (%).
a
Extended Criteria Donor: Age >55, DCD, PF < 300, Anticipated ischemia >6 h, abnormal chest X-ray, >20 py smoking history.
b
Major bleeding within the early postoperative period requiring surgical intervention.
CSAI: clinically significant airway ischemia, ILD: interstitial lung disease, PAH: pulmonary arterial hypertension, PVD: pulmonary vascular disease, LAS: lung allocation score, ICU: intensive care unit, ECMO: Extra-Corporeal Membrane Oxygenation, PAP: pulmonary arterial pressure, DBD: donor after brain death, DCD: donor after circulatory death, CPB: Cardio-Pulmonary Bypass, EVLP: Ex-Vivo Lung Perfusion.
PGD: primary graft dysfunction.