Background: Although the development of
noncardiogenic pulmonary edema or pulmonary reimplantation response
(PRR) after lung transplantation has been well described, the incidence
has not been established and the relationship of PRR to clinical risk
factors has not been analyzed.
Study objectives: (1)
To describe the incidence of PRR in lung transplant recipients, (2) to
identify the predictors of PRR, (3) to examine the correlation of
suspected predictors with the severity of PRR, and (4) to evaluate the
impact of PRR on morbidity and mortality of lung transplant
Design: Retrospective review of clinical
records and radiographic studies.
care referral center.
consecutive patients with end-stage lung disease undergoing lung
transplantation between February 1990 and October 1995.
Methods: Review of clinical records and postoperative chest
radiographs of all lung transplant recipients to identify patients who
experienced PRR. Chest radiographs of patients with PRR were graded for
severity on a scale of 0 (none) to 5 (very severe). Demographic, pre-
and perioperative factors were also evaluated along with short- and
long-term survival of patients with PRR.
Fifty-six of 99 lung transplant recipients (57%) experienced PRR. The
median ischemia time of patients with and without PRR was 168 and 180
min, respectively (p = 0.62). The incidence of PRR was 51% in
patients without preoperative pulmonary hypertension, 78% in mild to
moderate pulmonary hypertension, and 58% in patients with severe
pulmonary hypertension (p = 0.10). Incidence and severity of PRR was
similar in patients receiving right, left, or double-lung
transplantation. Similarly, age and sex of the recipients and
underlying lung disease did not affect the incidence or severity of
PRR. The incidence and severity of PRR was higher in patients
undergoing cardiopulmonary bypass during lung transplantation. Patients
with PRR had prolonged duration of mechanical ventilation and ICU stay.
Overall, PRR did not affect the survival of the patients. However,
survival of female lung transplant recipients was significantly better
than male recipients (median survival, 60 vs 21 months;
p = 0.02).
Conclusions: Acute pulmonary edema or PRR
occurs frequently (57%) after lung transplantation. In this series,
PRR was not associated with a prolonged ischemia time, preoperative
pulmonary hypertension, the type of lung transplant, underlying lung
disease, or age or sex of recipients. However, use of cardiopulmonary
bypass during surgery was associated with increased incidence and
severity of PRR. Also, the development of PRR resulted in prolonged
mechanical ventilation and a longer ICU stay, but did not affect
survival. Female lung transplant recipients survived significantly
longer than male recipients. The reason for this difference in survival