PURPOSE: Single lung transplantation (SLT) for ILD is a well-accepted treatment for end-stage ILD refractory to other therapies, but SLT may be complicated by significant native lung complications that can cause serious morbidity or early mortality. Previous reports of native lung complications have studied mixed populations including COPD, ILD, and pulmonary hypertension. We examined patients undergoing single lung transplant for ILD to evaluate the frequency and severity of post-transplant native lung complications and to determine their effect on post-transplant outcome.
METHODS: We reviewed the charts of 94 patients with ILD undergoing SLT between July 1991 and November 2009 to ascertain the incidence and type of post-transplant native lung complications and their effects on post-transplant outcome.
RESULTS: Among the 94 patients investigated, there were a total of 32 native lung complications in a total of 22 different patients. These included pneumonia (16), pneumothorax (4), bronchogenic carcinoma (3), aspergilloma (3), acute exacerbation of IPF in the native lung (2), hemoptysis from a native lung source (1), pleurocutaneous fistula (1), pleural effusion (1), and pulmonary embolism (1). Thirty-one of these complications required inpatient evaluation, nine required intubation with mechanical ventilation, and five required surgical intervention. In seven instances, native lung complications directly led to or significantly contributed to the death of the transplant recipient.
CONCLUSIONS: The native lung complication rate in this cohort of patients undergoing transplantation for ILD is higher than the previously reported incidence of complications from two prior studies of mixed populations of 13.8-15%, and lower than a third study that reported native lung complication rates of 50%. Native lung complications lead to significant morbidity and mortality in these transplant recipients.
CLINICAL IMPLICATIONS: Potential native lung complications need to be aggressively pursued and treated early to prevent morbidity and mortality. Surveillance should be directed to identifying complications and intervening as early as possible.
DISCLOSURE: The following authors have nothing to disclose: Jeremy Siegrist, Keith Meyer, Nilto DeOliveira
No Product/Research Disclosure Information