Original clinical science
Outcome of lung transplant recipients requiring readmission to the intensive care unit

https://doi.org/10.1016/j.healun.2010.08.016Get rights and content

Background

Lung transplantation is the recognized therapy for end-stage respiratory failure. Many serious medical complications have been described occurring from months to years after lung transplantation, often necessitating admission to an intensive care unit (ICU). We examined the factors associated with death.

Methods

All consecutive lung transplant recipients who were readmitted to the ICU > 30 days after transplantation from 2000 to 2009 were included in this retrospective study. Data were collected regarding demographic parameters, ICU stay, and outcome.

Results

During the study period, 40 patients were admitted to the ICU. The main pre-transplant diagnosis was idiopathic pulmonary fibrosis, followed by chronic obstructive pulmonary disease. Most patients (93%) required mechanical ventilation during their ICU stay. The main reason for ICU admission was septic shock in 22 patients (55%). An organism was isolated from 19 of these patients; in 11 patients, the organism was multidrug resistant. The ICU mortality was 62.5%. Non-survivors were characterized by more frequent readmissions to hospital (p = 0.02), a higher admission Sequential Organ Failure Assessment score (p = 0.02), an admission diagnosis of sepsis (87.5% vs 37.5% for all other diagnoses, p < 0.001), and a requirement for mechanical ventilation (p = 0.02). The incidence of bronchiolitis obliterans syndrome was also significantly higher in non-survivors (p = 0.02).

Conclusions

Severe sepsis remains the most important factor associated with a poor outcome after readmission to ICU. New strategies are required to alter the course of this common complication of lung transplantation.

Section snippets

Setting

This retrospective study was done at the Rabin Medical Center, a tertiary care, university-affiliated hospital, where an average of 40 lung transplantation procedures from brain-dead, deceased donors are performed annually. After transplantation, patients are admitted to the thoracic surgery ICU for post-surgical care. During the study period, from December 2000 to December 2009, 322 lung transplantation procedures were performed.

Immunosuppression

After transplantation, all patients received the following

Patient characteristics

During the study period, 40 patients required readmission to the general ICU. Of these, 39 had been discharged home after initial post-operative care, and 1 patient had been discharged from the thoracic ICU but remained in the hospital. Patient characteristics are reported in Table 1. The main pre-transplant diagnosis was idiopathic pulmonary fibrosis, followed by chronic obstructive pulmonary disease. Most patients received a single-lung transplant, usually of the left lung. Chronic rejection

Discussion

Readmission of lung transplant recipients to our ICU was associated with a high mortality, namely 62.5%. This is a higher mortality than that reported for patients undergoing transplantation of other organs who require ICU readmission, namely between 12% and 18% for patients undergoing liver transplantation12, 13 and between 36.8% and 40.3% for those undergoing kidney transplantation.14, 15 It is thus important to identify the factors associated with this high mortality and attempt to modify or

Disclosure statement

None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

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