SESSION TITLE: Lung Transplantation Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: Diaphragm dysfunction after lung transplantation is considered to represent a major source of morbidity for patients and compromise their quality of life; however, the underlying mechanisms appear to be complex/multi-factorial and their impact on outcomes in lung transplantation remains largely unknown.
METHODS: Patients who received lung transplants at our institution between January 2007 and December 2012 were identified (n=702). Data on complications including occurrence, timing, management and outcome were extracted from our transplant database and medical record review. Diaphragm dysfunction following lung transplantation was defined based on positive results for sniff test performed under fluoroscope.
RESULTS: Thirty two patients (4.5%) experienced diaphragm dysfunction within 1 month after lung transplantation. Six patients (19%) had pre-existing unilateral diaphragm dysfunction and others (81%) had new onset of diaphragm dysfunction after the surgery. There were 2 in-hospital deaths. The 90-day, 1- and 5-year survivals were 89%, 78% and 52%, respectively. All patients with pre-existing diaphragm dysfunction underwent double lung transplantation and survived longer than 3 years with acceptable pulmonary function. Patient major comorbidities included severe primary graft dysfunction requiring postoperative extracorporeal membrane oxygenation (ECMO; 3 patients), acute renal insufficiency (5 patients), and prolonged mechanical ventilator support (15 patients). Their average posttransplant peak FEV1.0 was 70%. In multivariate analysis, prolonged cardiopulmonary bypass use (>4 hours), prior cardiothoracic surgery, and prior ECMO increased the risk of severe diaphragm dysfunction followed by mortality (p<0.05).
CONCLUSIONS: Diaphragm dysfunction is a well-documented complication after lung transplantation; however, despite increasing number of patients with prior cardiothoracic surgery being referred to our institution to consider for lung transplantation, the incidence was 4%. In addition, in most of the cases with diaphragm dysfunction, it was transient and not associated with significantly adverse posttransplant outcomes.
CLINICAL IMPLICATIONS: The impact of diaphragm dysfunction after lung transplantation on short- and long-term outcomes has been defined. This report presents the largest series of patients with diaphragm dysfunction who underwent lung transplantation to date.
DISCLOSURE: The following authors have nothing to disclose: Norihisa Shigemura, Jonathan D'Cunha, Jay Bhama, Cynthia Gries, Maria Crespo, Joseph Pilewski, Christian Bermudez
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