Hemodynamic failure and graft dysfunction after lung transplant: A possible clinical continuum with immediate and long‐term consequences

Introduction The postoperative hemodynamic management after lung transplant (LUTX) is guided by limited evidence. We aimed to describe and evaluate risk factors and outcomes of postoperative vasoactive support of LUTX recipients. Methods In a single‐center retrospective analysis of consecutive adult...

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Published in:Clinical transplantation 2023-12, Vol.37 (12), p.e15122-n/a
Main Authors: Scaravilli, Vittorio, Guzzardella, Amedeo, Madotto, Fabiana, Morlacchi, Letizia Corinna, Bosone, Marco, Bonetti, Claudia, Musso, Valeria, Rossetti, Valeria, Russo, Filippo Maria, Sorbo, Lorenzo Del, Blasi, Francesco, Nosotti, Mario, Zanella, Alberto, Grasselli, Giacomo
Format: Article
Language:English
Subjects:
hemodynamics
lung transplant
primary graft dysfunction
vasoactive support
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Summary:Introduction The postoperative hemodynamic management after lung transplant (LUTX) is guided by limited evidence. We aimed to describe and evaluate risk factors and outcomes of postoperative vasoactive support of LUTX recipients. Methods In a single‐center retrospective analysis of consecutive adult LUTX, two cohorts were identified: (1) patients needing prolonged vasoactive support (>12 h from ICU admission) (VASO+); (2) or not (VASO−). Postoperative hemodynamic characteristics were thoroughly analyzed. Risk factors and outcomes of VASO+ versus VASO− cohorts were assessed by multivariate logistic regression and propensity score matching. Results One hundred and thirty‐eight patients were included (86 (62%) VASO+ versus 52 (38%) VASO−). Vasopressors (epinephrine, norepinephrine, dopamine) were used in the first postoperative days (vasoactive inotropic score at 12 h: 6 [4–12]), while inodilators (dobutamine, levosimendan) later. Length of vasoactive support was 3 [2–4] days. Independent predictors of vasoactive use were: LUTX indication different from cystic fibrosis (p = .003), higher Oto score (p = .020), longer cold ischemia time (p = .031), but not preoperative cardiac catheterization. VASO+ patients showed concomitant hemodynamic and graft impairment, with longer mechanical ventilation (p = .010), higher primary graft dysfunction (PGD) grade at 72 h (PGD grade > 0 65% vs. 31%, p = .004, OR 4.2 [1.54–11.2]), longer ICU (p 
ISSN:0902-0063
1399-0012
DOI:10.1111/ctr.15122