Original clinical scienceOutcome of lung transplant recipients requiring readmission to the intensive care unit
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.
References (27)
- et al.
Respiratory failure and sepsis are the major causes of ICU admissions and mortality in survivors of lung transplants
Chest
(2003) - et al.
Prognosis factors in lung transplant recipients readmitted to the intensive care unit
Transplant Proc
(2007) - et al.
Outcome of lung transplant patients admitted to the medical ICU
Chest
(2004) - et al.
Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria
J Heart Lung Transplant
(2002) - et al.
Readmission to an intensive care unit following liver and kidney transplantation: a 50-month study
Transplant Proc
(1999) - et al.
Sepsis in transplanted patients: beyond antibiotic therapy
Transplant Proc
(2008) - et al.
Experimental and clinical significance of endotoxin-dependent HLA-DR expression on monocytes
J Surg Res
(1989) - et al.
Selective defects of T lymphocyte function in patients with lethal intraabdominal infection
Am J Surg
(1999) - et al.
Cylex ImmuKnow assay levels are lower in lung transplant recipients with infection
J Heart Lung Transplant
(2008) - et al.
Trends in organ donation and transplantation in the United States, 1998–2007
Am J Transplant
(2008)
Medical complications after lung transplantation
Semin Resp Crit Care Med
Organ utilization among deceased donors in Canada, 1993–2002
Can J Anesth
APACHE II: A severity of disease classification system
Crit Care Med
Cited by (17)
Critical Care Management of the Lung Transplant Recipient
2023, Clinics in Chest MedicineConsequences of ICU Readmission After Lung Transplantation: Beyond the Early Postoperative Period
2022, Archivos de BronconeumologiaIntensive care readmissions in the first year after lung transplantation: Incidence, early risk factors and outcome
2021, Anaesthesia Critical Care and Pain MedicineCitation Excerpt :Despite an improved survival rate reported in the most recent cohorts [1], lung transplant recipients are frequently exposed to serious medical complications requiring hospital readmission. Few studies have addressed this issue, most of them are based on a retrospective analysis [2–10]. According to previous studies, hospital readmissions after lung transplantation (LT) are mainly related to pulmonary complications (59%), followed by gastrointestinal (18%), cardiac (5%), metabolic (2.5%) and neurologic complications (2.5%) [6].
Pattern and Predictors of Hospital Readmission During the First Year After Lung Transplantation
2017, American Journal of TransplantationTiming and Frequency of Unplanned Readmissions After Lung Transplantation Impact Long-Term Survival
2016, Annals of Thoracic SurgeryCitation Excerpt :Improving strategies to prevent these adverse events should be a primary focus of lung transplantation programs and may lead to a reduction in unplanned readmissions and improve long-term outcomes. Respiratory infections are common in LT recipients [14] and represented the most common cause of unplanned readmissions in our patients, and two published investigations have identified septic shock as the main cause of readmissions to the ICU and death after initially successful LT [11, 12]. Respiratory adverse events can have critical effects on LT outcomes.
Characteristics and outcomes of patients with lung transplantation requiring admission to the medical ICU
2014, ChestCitation Excerpt :This is despite the incidence of ventilator support as well as the critical illness score (APACHE III) being similar or higher compared with earlier reports. Nonetheless, the difference may be partially attributed to heterogeneity among centers regarding policies pertaining to MICU admissions.4–7 Also, general advances in critical care may also explain some of the differences, as the first two studies reported patient outcomes from > 10 years ago.4,5