Perioperative mortality of lung transplantation in chronic obstructive pulmonary disease

Autores de IIS La Fe

• José Cerón Navarro

  Autor

• Nuria Mancheño Franch

  Autor

• Francisco José Vera Sempere

  Autor

Participantes ajenos a IIS La Fe

• Quevedo, KD
• Aragon, CJ
• Cuesta, JCP
• Alarcon, JP

Abstract

Introduction: Lung transplantation (LT) has been considered an alternative therapeutic approach in terminal patients. However, this process in COPD is not controversy-free. This paper aimed to analyze 30-day mortality (PM) patterns and their risk factors in COPD patients undergoing LT. Patients and method: A retrospective cohort with 107 COPD patients, transplanted at the University La Fe Valencia, Spain, treated from January 1991 to December 2008. Demographics values, degree of dyspnoea, diagnosis, BODE index, single versus bilateral LT, cardio-pulmonary bypass, donor age, steroid dependence, presence of bronchiectasis, retrograde perfusion, transfusion of blood products, and PaO2/FiO(2) were analyzed. Continuous variables were expressed as mean +/- SD and categorical variables as absolute frequency and percentage. A Cox regression model was used for multivariate analysis. Results: Ninety-four men and 13 women of a mean age of 52.58 +/- 8.05 years were transplanted. Of all patients, 75% obtained a BODE score above 7. There were 76 bilateral LT. PM was established at 14%. Main causes of death were infection (53.3%) and surgical complications (33.3%). Presence of bronchiectasis and chronic use of corticosteroids, donor/recipient difference.in size and presence of fat in retrograde perfusion fluid were important risk factors for PM. Moreover, PaO2/FiO(2) ratio at 6h was a protective factor for the event, thus a higher ratio value, lowered the risk of PM. Conclusions: LT is a procedure with a high PM rate. Use of corticosteroids, the presence of bronchiectasis and fat emboli in the retrograde reperfusion, and PaO2/FiO(2) significantly determine PM. (C) 2016 Elsevier Espana, S.L.U. All rights reserved.

Keywords

• Chronic pulmnary obstructive disease; Lung transplantation; Perioperative mortality