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Transplantation |

Complications in the Immediate Postoperatory of Lung Transplantation: Three Years of Practice at a High-Experienced Center

Jordi Riera, MD; Berta Caralt, MD; Salvador Augustin, PhD; Joan Ramon Masclans, PhD; Merce Canela, PhD; Antonio Roman, PhD; Jordi Rello, PhD
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ICU, Vall d'Hebron Hospital, Barcelona, Spain


Chest. 2014;145(3_MeetingAbstracts):631A. doi:10.1378/chest.1799525
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Abstract

SESSION TITLE: Transplantation Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: We retrospectively reviewed the complications occurred in the immediate postoperatory (IPO) of lung transplantation (LTx).

METHODS: A single-center cohort of 170 consecutive LTx performed between 2010 and 2012 was studied. Complications in the IPO have been analyzed and their relation with outcomes has been examined. Factors predisposing to the appearance of these complications have been identified.

RESULTS: Overall in-hospital mortality was 14.1%. Forced expiratory volume in 1 second (FEV1) at 6 months was 66.04%. A total of 143 infectious cases occurred in 57% of the population. A total of 55 episodes of tracheobronchitis occurred in 24.7% of the patients, whilst 24 cases of pneumonia occurred in 11.7%. Pneumonia was related with more probability of in-hospital death (42.9% vs 11.5%; p 0.01). Tracheobronchitis was not related to this increase in mortality (14.0% vs 14.7%; p 0.9). Only 19.4% of the population was admitted without any grade of primary graft dysfunction (PGD). Grade I PGD was present in 21.8%, grade II in 15.9% and grade III in 42.9%. Grade III was associated to higher in-hospital mortality (19.2%) and worst FEV1 at 6 months (63.15%) although no statistically significant difference against other grades was found. Acute graft rejection was diagnosed in 13.5% of the population (60.8% cellular-mediated, 21.7% humoral and 17.5% with signs of both). Phrenic paresis complicated the course of 25.9% of the patients, whilst gastric paresis appeared in 32.4%. We observed a statistically significant association between both entities (Pearson’s r=0.415; p<0.001). Patients with gastric paresis had more episodes of tracheobronchitis (38.2% vs 11.3%; p<0.001) and pneumonia (18.2% vs 3.5%; p<0.01) having a statistically significant increase of mortality (21.8% vs 10.4%; p 0.04; OR 2.33, IC95% 0.93-5.8).

CONCLUSIONS: Complications in the IPO of LTx are frequent. PGD at any grade is the most frequent complication. Both pneumonia and gastric paresis are associated with an increase of mortality.

CLINICAL IMPLICATIONS: Incidence and consequences of complications in the IPO of LTx have changed over the years. Efforts should be made to prevent the apparition of gastric paresis and pneumonia.

DISCLOSURE: Jordi Rello: Grant monies (from sources other than industry): Study financed partly with Spanish Government Grant FIS PI11/01122 The following authors have nothing to disclose: Jordi Riera, Berta Caralt, Salvador Augustin, Joan Ramon Masclans, Merce Canela, Antonio Roman

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