Surgical Risk Factors Associated With Lung Transplantation

• Published in: Transplantation proceedings 2009-07, Vol.41 (6), p.2218-2220
• Main Authors: Paradela, M, González, D, Parente, I, Fernández, R, De La Torre, M.M, Delgado, M, García, J.A, Fieira, E, Bonhome, C, Maté, J.M.B
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Epidemiology; Female; Functional Laterality; Fundamental and applied biological sciences. Psychology; Fundamental immunology; General aspects; Hemorrhage - epidemiology; Hemorrhage - mortality; Humans; Hypertension, Pulmonary - epidemiology; Hypertension, Pulmonary - mortality; Lung Diseases - surgery; Lung Transplantation - adverse effects; Lung Transplantation - mortality; Male; Medical sciences; Middle Aged; Perioperative Care - mortality; Perioperative Care - statistics & numerical data; Postoperative Complications - mortality; Public health. Hygiene; Public health. Hygiene-occupational medicine; Pulmonary Disease, Chronic Obstructive - surgery; Pulmonary Emphysema - surgery; Pulmonary Fibrosis - surgery; Retrospective Studies; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Wound Infection - epidemiology; Surgical Wound Infection - mortality; Tissue, organ and graft immunology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.06.016

Abstract Background Despite years of experience with lung transplantation, perioperative morbidity rates remain high. The objective of this study was to analyze our series of lung transplant recipients, seeking to identify possible intra- and postoperative risk factors associated with mortality. Patients and Methods We performed a descriptive, retrospective study of 224 consecutive patients undergoing lung transplantation over a period of 112 months; we excluded retransplant procedures. We gathered details of the surgical procedure and postoperative period in the recovery unit. Univariate analysis using the chi-square test identified variables associated with the incidence of mortality. Results From 1999 to 2008, we performed 224 lung transplants, including 66% in men and 34% in women. Their overall mean age was 49.9 ± 13.5 years. The conditions that led to transplantation were pulmonary fibrosis (38.4%); chronic obstructive pulmonary disease emphysema (29%); cystic fibrosis (10.7%); bronchiectasis (8.9%); pulmonary hypertension (3.1%); and other diseases (9.9%). A total of 124 (55.4%) patients underwent single and 100 (44.6%) received sequential bilateral lung transplantations. Surgical risk factors were identified in 51.3% of the cases, the most frequent being hemorrhage (25.3%), followed by severe pulmonary hypertension (14.7%) and cardiopulmonary bypass (12.1%). Greater perioperative mortality was detected among patients with surgical risk factors, namely, significantly related to cardiopulmonary bypass, pulmonary hypertension, and air leak. A higher frequency of surgical risk factors was observed among patients with bilateral lung transplantations and longer procedures, but they were not associated with greater perioperative mortality. Reoperation was necessary in 16 patients (7.2%), mainly owing to bleeding, it was not significantly related to mortality risk. Conclusions The incidence of surgical risk factors in lung transplantation was high, especially in bilateral lung transplantations and prolonged procedures. Postoperative bleeding requiring reoperation was not frequent and not associated with increased preoperative mortality in our series.