SESSION TITLE: Post-Transplant Complications
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 28, 2013 at 07:30 AM - 09:00 AM
PURPOSE: Increasing number of patients are undergoing lung transplantation (LT) every year and many of these patients have episodes of decompensation requiring admission to medical intensive care unit (MICU). We sought to identify variables that predict survival at 6 months after MICU admission among these patients.
METHODS: This study was part of an ongoing registry study among all the patients admitted to MICU (a 53 bedded closed unit) at the Cleveland Clinic. Between July 2011-2012, 101 patients with LT were admitted to the MICU (mean age 55.4 ± 12.6 years, M:F 53:48, Caucasians 89%). Data regarding baseline variables including duration since transplant, history of bronchiolitits obliterans syndrome (BOS), use of antimetabolites, type of calcineurin inhibitor (CNI) and pre-admission FEV1, indication for MICU admission, need of ventilator support, length of ICU stay and hospital survival was recorded. Among the patients surviving to hospital discharge (n=88, 87.1%, mean age 55±12.3 years, M:F 45:43), functional status at discharge, discharge disposition and outcome at 6 months was recorded. Study group was divided into two groups based upon survival at 6 months and variables were compared between survivors at 6 months versus the rest to identify predictors of 6 month outcome.
RESULTS: Six month survival was 64.8% (57/88). On univariate analysis, demographics, type or indication of transplant, duration since transplant, history of BOS, use of antimetabolites, type of CNI or pre-ICU admission FEV1 had no association with 6 month survival. However, APACHE III score at admission to the MICU (77±24 vs 61±24, P=0.003), MICU lenght of stay (8.4±8.9 vs 5.2±5.4 days, P=0.048) and functional status at the time of discharge (survival 54.9% for partly or fully dependent vs 75.7% for independent) were associated with 6 month outcome. On multivariate analysis, functional status at the time of discharge emerged as the only independent predictor of survival at 6 months (adjusted OR: 5.1, 1.1-22.7, p=0.035).
CONCLUSIONS: More than one third of the patients with LT after MICU admission do not survive till 6 months after discharge. Functional status at the time of hospital discharge is an independent predictor of outcome among these patients.
CLINICAL IMPLICATIONS: Patients with LT have significant short term mortality after discharge from MICU. Patients who are partly or fully dependent have more than 5 times increased mortality at 6 months as compared to those who are independent at the time of discharge.
DISCLOSURE: The following authors have nothing to disclose: Amit Banga, Debasis Sahoo, Marie Budev, Olufemi Akindipe, Charles Lane, Puneet Garcha, Madhu Sasidhar
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