Original Article
Mortality Analysis of Patients Undergoing Lung Transplantation for Emphysema
Trasplante de pulmón en casos de enfisema: análisis de la mortalidad
Eduardo Miñambresa,
, Felipe Zurbanob, Sara Naranjoc, Javier Llorcad, José Manuel Cifriánb, Alejandro González-Castroa
Corresponding author
a Servicio de Medicina Intensiva, Unidad de Trasplante Pulmonar, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
b Servicio de Neumología, Unidad de Trasplante Pulmonar, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
c Servicio de Cirugía Torácica, Unidad de Trasplante Pulmonar, Hospital Universitario Marqués de Valdecilla, Unidad de Trasplante Pulmonar, Santander, Cantabria, Spain
d Departamento de Epidemiología y Biología Computacional, Universidad de Cantabria, CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Cantabria, Spain
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Naranjo, Javier Llorca, José Manuel Cifrián, Alejandro González-Castro" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Eduardo" "apellidos" => "Miñambres" "email" => array:1 [ 0 => "eminambres@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Felipe" "apellidos" => "Zurbano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "Sara" "apellidos" => "Naranjo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 3 => array:3 [ "nombre" => "Javier" "apellidos" => "Llorca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] ] 4 => array:3 [ "nombre" => "José Manuel" "apellidos" => "Cifrián" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 5 => array:3 [ "nombre" => "Alejandro" "apellidos" => "González-Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Unidad de Trasplante Pulmonar, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Unidad de Trasplante Pulmonar, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Unidad de Trasplante Pulmonar, Hospital Universitario Marqués de Valdecilla, Unidad de Trasplante Pulmonar, Santander, Cantabria, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Departamento de Epidemiología y Biología Computacional, Universidad de Cantabria, CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Cantabria, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trasplante de pulmón en casos de enfisema: análisis de la mortalidad" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-11-01" "fechaAceptado" => "2009-01-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec155759" "palabras" => array:3 [ 0 => "Lung transplantation" 1 => "Emphysema" 2 => "Prognosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec155758" "palabras" => array:3 [ 0 => "Trasplante pulmonar" 1 => "Enfisema" 2 => "Pronóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p class="elsevierStyleSimplePara elsevierViewall">The outcomes of lung transplantation 11 years after starting the transplantation program in our hospital are presented. Risk factors associated with short-, medium-, and long-term mortality in transplant recipients were analyzed.</p> <span class="elsevierStyleSectionTitle">Patients and Methods</span><p class="elsevierStyleSimplePara elsevierViewall">All patients diagnosed with emphysema who underwent lung transplantation between March 1997 and June 2008 were included. The association between different study variables and early death and death at 1 year and 5 years was studied. The Kaplan-Meier method was used to analyze survival. A logistic regression model was used to study the association between early death and variables with a trend towards significance (<span class="elsevierStyleItalic">P</span><.2) in the univariate analysis. The risk factors for mortality at 1 year and 5 years were analyzed by a Cox regression model.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">A total of 92 patients were included. Survival was 89.3%, 70%, and 54% at 1 month, 1 year, and 5 years after transplantation, respectively. Dehiscence of the surgical suture (<span class="elsevierStyleItalic">P</span><.001), duration of mechanical ventilation in the intensive care unit (<span class="elsevierStyleItalic">P</span>=.04), duration of the surgical procedure (<span class="elsevierStyleItalic">P</span><.001), and single-lung transplantation (<span class="elsevierStyleItalic">P</span>=.007) were the variables associated with mortality. Extracorporeal circulation and the need for hemodiafiltration in the intensive care unit increased the short-term risk of death (<span class="elsevierStyleItalic">P</span><.05). The age of the recipient was the variable associated with long-term mortality (<span class="elsevierStyleItalic">P</span>=.02). The duration of the surgical intervention was associated with an increase in short-, medium-, and long-term mortality.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Complications were responsible for short-term mortality, while age of the recipient was the most important factor in determining long-term survival. Mortality was higher in single-lung transplant recipients compared to double-lung transplant recipients.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p class="elsevierStyleSimplePara elsevierViewall">Se presentan los resultados del trasplante pulmonar (TP) en casos de enfisema, tras 11 años desde el inicio del programa de TP, y se analizan los factores de riesgo asociados a la mortalidad a corto, medio y largo plazo en los receptores del trasplante.</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha incluido a todos los pacientes diagnosticados de enfisema que recibieron un TP entre marzo de 1997 y junio de 2008. Se analizó la asociación de las diferentes variables estudiadas con la mortalidad precoz, anual y al quinto año. Se realizó un análisis de supervivencia mediante el método de Kaplan-Meier. Mediante regresión logística se estudió la asociación entre las variables que en el análisis univariante habían mostrado tendencia a la significación estadística (p < 0,2) frente a la mortalidad precoz. Los factores de riesgo para la mortalidad anual y al quinto año se analizaron mediante regresión de Cox.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluyó en total a 92 pacientes. La tasa de supervivencia fue del 89,3, el 70 y el 54% al mes, al año y al quinto año del trasplante. La dehiscencia de la sutura quirúrgica (p < 0,001), el tiempo de ventilación mecánica en la Unidad de Cuidados Intensivos (p = 0,04), la duración de la intervención quirúrgica (p < 0,001) y la realización de un trasplante unipulmonar (p = 0,007) fueron las variables asociadas a la mortalidad. El uso de circulación extracorpórea y la necesidad de técnicas de hemodiafiltración en la Unidad de Cuidados Intensivos incrementaron el riesgo de muerte a corto plazo (p < 0,05). La edad del receptor fue la variable asociada a la mortalidad a largo plazo (p = 0,02). La duración de la intervención quirúrgica se asoció a un incremento de la mortalidad a corto, medio y largo plazo.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Las complicaciones son las responsables del incremento de la mortalidad a corto plazo, mientras que la edad del receptor es la variable que mayor influencia tiene en la mortalidad a largo plazo. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 2 | 10 |
| 2024 October | 36 | 12 | 48 |
| 2024 September | 33 | 19 | 52 |
| 2024 August | 53 | 41 | 94 |
| 2024 July | 36 | 18 | 54 |
| 2024 June | 49 | 27 | 76 |
| 2024 May | 51 | 24 | 75 |
| 2024 April | 21 | 21 | 42 |
| 2024 March | 36 | 15 | 51 |
| 2024 February | 53 | 15 | 68 |
| 2023 March | 1 | 2 | 3 |
| 2023 February | 19 | 24 | 43 |
| 2023 January | 17 | 25 | 42 |
| 2022 December | 17 | 23 | 40 |
| 2022 November | 22 | 26 | 48 |
| 2022 October | 17 | 34 | 51 |
| 2022 September | 10 | 18 | 28 |
| 2022 August | 21 | 33 | 54 |
| 2022 July | 14 | 34 | 48 |
| 2022 June | 12 | 30 | 42 |
| 2022 May | 22 | 25 | 47 |
| 2022 April | 14 | 24 | 38 |
| 2022 March | 15 | 33 | 48 |
| 2022 February | 16 | 28 | 44 |
| 2022 January | 13 | 36 | 49 |
| 2021 December | 15 | 51 | 66 |
| 2021 November | 22 | 55 | 77 |
| 2021 October | 47 | 53 | 100 |
| 2021 September | 17 | 55 | 72 |
| 2021 August | 25 | 31 | 56 |
| 2021 July | 11 | 33 | 44 |
| 2021 June | 25 | 34 | 59 |
| 2021 May | 23 | 29 | 52 |
| 2021 April | 28 | 53 | 81 |
| 2021 March | 27 | 30 | 57 |
| 2021 February | 17 | 12 | 29 |
| 2021 January | 11 | 15 | 26 |
| 2020 December | 14 | 17 | 31 |
| 2020 November | 12 | 13 | 25 |
| 2020 October | 16 | 12 | 28 |
| 2020 September | 10 | 5 | 15 |
| 2020 August | 14 | 12 | 26 |
| 2020 July | 13 | 14 | 27 |
| 2020 June | 9 | 6 | 15 |
| 2020 May | 14 | 15 | 29 |
| 2020 April | 19 | 17 | 36 |
| 2020 March | 23 | 10 | 33 |
| 2020 February | 17 | 14 | 31 |
| 2020 January | 20 | 13 | 33 |
| 2019 December | 16 | 14 | 30 |
| 2019 November | 14 | 9 | 23 |
| 2019 October | 8 | 8 | 16 |
| 2019 September | 8 | 4 | 12 |
| 2019 August | 10 | 15 | 25 |
| 2019 July | 13 | 10 | 23 |
| 2019 June | 9 | 4 | 13 |
| 2019 May | 13 | 5 | 18 |
| 2019 April | 28 | 14 | 42 |
| 2019 March | 23 | 19 | 42 |
| 2019 February | 15 | 6 | 21 |
| 2019 January | 9 | 5 | 14 |
| 2018 December | 16 | 10 | 26 |
| 2018 November | 19 | 16 | 35 |
| 2018 October | 19 | 15 | 34 |
| 2018 September | 13 | 6 | 19 |
| 2018 May | 3 | 1 | 4 |
| 2018 April | 9 | 3 | 12 |
| 2018 March | 6 | 2 | 8 |
| 2018 February | 5 | 7 | 12 |
| 2018 January | 10 | 6 | 16 |
| 2017 December | 10 | 9 | 19 |
| 2017 November | 7 | 4 | 11 |
| 2017 October | 8 | 13 | 21 |
| 2017 September | 6 | 13 | 19 |
| 2017 August | 9 | 6 | 15 |
| 2017 July | 18 | 10 | 28 |
| 2017 June | 11 | 12 | 23 |
| 2017 May | 4 | 5 | 9 |
| 2017 April | 4 | 5 | 9 |
| 2017 March | 5 | 4 | 9 |
| 2017 February | 5 | 3 | 8 |
| 2017 January | 4 | 3 | 7 |
| 2016 December | 4 | 7 | 11 |
| 2016 November | 7 | 11 | 18 |
| 2016 October | 6 | 15 | 21 |
| 2016 September | 6 | 8 | 14 |
| 2016 August | 6 | 4 | 10 |
| 2016 July | 6 | 7 | 13 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2016 January | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 52 | 15 | 67 |
| 2015 September | 54 | 5 | 59 |
| 2015 August | 32 | 11 | 43 |
| 2015 July | 32 | 4 | 36 |
| 2015 June | 41 | 7 | 48 |
| 2015 May | 61 | 10 | 71 |
| 2015 April | 27 | 10 | 37 |
| 2015 March | 22 | 5 | 27 |
| 2015 February | 27 | 3 | 30 |
| 2015 January | 31 | 3 | 34 |
| 2014 December | 32 | 5 | 37 |
| 2014 November | 29 | 9 | 38 |
| 2014 October | 53 | 8 | 61 |
| 2014 September | 29 | 10 | 39 |
| 2014 August | 33 | 7 | 40 |
| 2014 July | 33 | 16 | 49 |
| 2014 June | 47 | 4 | 51 |
| 2014 May | 57 | 13 | 70 |
| 2014 April | 49 | 7 | 56 |
| 2014 March | 58 | 8 | 66 |
| 2014 February | 46 | 8 | 54 |
| 2014 January | 35 | 6 | 41 |
| 2013 December | 36 | 8 | 44 |
| 2013 November | 34 | 5 | 39 |
| 2013 October | 33 | 8 | 41 |
| 2013 September | 52 | 8 | 60 |
| 2013 August | 26 | 5 | 31 |
| 2013 July | 50 | 10 | 60 |
| 2013 June | 21 | 8 | 29 |
| 2013 May | 28 | 6 | 34 |
| 2013 April | 12 | 8 | 20 |
| 2013 March | 7 | 2 | 9 |
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