Background: Long-term mechanical ventilation is
considered as a relative or absolute contraindication for lung
transplantation by most centers. We report on the results of
transplantation in nine patients requiring long-term mechanical
ventilation at two lung transplant centers.
The study group (group 1) consisted of nine patients receiving
mechanical ventilation who underwent lung transplantation at either
Duke University Medical Center or the University of Florida between
1992 and 1997. Patients in group 1 met the following criteria: they
underwent exercise therapy with a physical therapist, and they were
without panresistant bacterial airway colonization. The study patients
that met these criteria spent at least 13 days receiving mechanical
ventilation prior to transplantation. The control population (group 2;
n = 65) consisted of all patients who underwent transplantation at
either center in the calendar year 1997 who were ventilator
independent. The 1-year survival rates in each group were calculated by
the Kaplan-Meier method. The number of days required for extubation in
each group were compared by the nonparametric Wilcoxon rank sum test.
The FEV1 value at 1 year was reported in each group.
Results: The 1-year survival rates were 78% and 83% in
group 1 and group 2, respectively. The mean number of days required
until extubation were 41 days in group 1 and 9 days in group 2
(p < 0.01). The allograft function was comparable in the two groups
at 1 year.
Conclusions: In a select population of
ventilator-dependent patients, the 1-year survival rate is comparable
to the standard lung transplant population. However, these
ventilator-dependent patients require a significantly longer time until
extubation than other transplant