Short-term survival after lung transplantation has improved such that over 90% of recipients are discharged post-operatively. Long term survival, however, can be complicated by the need for readmission to an ICU in many patients. Respiratory failure is the most common cause for re-admission, however,we found that a significant number of admissions are required for non-pulmonary issues. The purpose of this study is to evaluate the nature and frequency of icu readmissions post transplant.
We performed a single center review of 83 consecutive lung transplant recipients who were successfully discharged post transplant between 1/1999 and 4/2004. Evaluation included patient demographics, pretransplant diagnoses, and time and diagnoses of admission to University Hospital’s ICU up until 7/2004. Patient charts and ICD-9 codes were used to document distribution of the primary diagnoses. Demographics were compared to patients who did not require readmission during the study period.
A total of 83 single (21%)and bilateral (79%)lung transplants were performed at our institution from 1/99 to 5/2004. 28 patients(34%) required re-admission to University Hospital’s ICU 49 times until 7/2004. Demographics including age, type of transplant, sex, and pre-transplant diagnosis were not significantly different from those not requiring re-admission. Distribution of primary readmission diagnoses are outlined in Table 1. Pulmonary dysfunction was the major complication leading to ICU admission (59%). 41% of admissions were distributed between non-pulmonary complications. Time to readmission ranged from 27 days to 540 days with a mean of 200 days.
Respiratory failure was the most common reason for readmission to our ICU post lung transplantation. However, there was a distinct subset of characteristic non-pulmonary issues that occurred with enough frequency (41%), that they warrant further evaluation.
Further study is needed to identify which clinical factors (pre-transplant co-morbidities,immunosuppression,etc), either pre- or post transplantation, may predict a return to the ICU after initial discharge following transplantation.
Primary Diagnoses for Lung Transplant Recipients Readmitted to the ICUCausePercentPulmonary59% (pneumonia, rejection, pleural effusion, pulmonary embolus)Cardiac10%Hematologic/Oncologic8%Neurologic8%Infectious Disease (not including pneumonia)6%Renal6%Endocrine2%
Deborah Levine, None.