PURPOSE: The purpose of the study was to review the incidence and clinical consequences of developing acute pulmonary embolism (PE) following lung transplantation (LT).
METHODS: One-hundred consecutive LTs were performed at Mayo Clinic Jacksonville from June 2001 to September 2005. A retrospective review of our Lung Transplant Data Base identified patients developing PE following LT. Demographics, outcomes and hospitalization data was analyzed using descriptive statitics and Student's T tests.
RESULTS: The first 100 LTs included 62 Single-Lung, 32 Double-Lung, and 6 Heart-Lung Transplants. The Mean±SD age was 55±13 years (range 16-74). Indications for transplant included Idiopathic Pulmonary Fibrosis (43), COPD (35), Pulmonary Hypertension (8), Cystic Fibrosis (3), Lymphangioleiomyomatosis (3) and others (8). The one-month survival rate was 98% and the one-year survival was 81%. These patients required a median of 3 days of ICU care and 14 days of hospitalization per transplant episode. Eight patients developed PE (PE+Group) following LT, and 92 did not (PE-Group). PE ocurred in average 4±4 months after transplant(range 1.9 to 12.1). Five/eight episodes produced obstructive shock, three episodes were fatal. Five patients survived PE; 3 died subsequently (5,10 and 18 months later), and 2 remain alive 12 and 24 months post PE. Patients in the PE+Group were significantly older (68±5 vs 54±13 years -p<0.001). There were no statistical differences in ICU or hospital days acutely post-transplant. The PE+Group required significantly higher number of repeat admissions to hospital for acute care in the first year: (2.8±2 vs 1.2±2 -p=0.02), they required more admissions to ICU (1.6±2 vs 0.2±0.7 -p<0.001). The PE+Group required larger number of in-patient days in the first year post-LT than the PE-Group: (104±126 vs 12±32 -p<0.001). One-year survival was 50% for the PE+Group and 84% for the PE-Group.
CONCLUSION: 1. PE occurs infrequently among LT recipients (8%). 2. PE occurs more frequently among older LT recipients. 3. PE post-LT significantly increases morbidity and mortality.
CLINICAL IMPLICATIONS: Older (>65) LT recipients are at higher risk of developing PE, special and prolonged DVT prophylactic therapy may prevent this complication.
DISCLOSURE: Cesar Keller, None.