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Original Research: Critical Care |

Characteristics and Outcomes of Patients With Lung Transplantation Requiring Admission to the Medical ICUMedical ICU Admission After Lung Transplantation

Amit Banga, MD, FCCP; Debasis Sahoo, MD; Charles R. Lane, MD; Atul C. Mehta, MD, FCCP; Olufemi Akindipe, MD; Marie M. Budev, DO, MPH, FCCP; Xiao-Feng Wang, PhD; Madhu Sasidhar, MD, FCCP
Author and Funding Information

From the Respiratory Institute (Drs Banga, Sahoo, Lane, Mehta, Akindipe, Budev, and Sasidhar), and the Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute (Dr Wang), Cleveland Clinic Foundation, Cleveland, OH.

CORRESPONDENCE TO: Amit Banga, MD, FCCP, Respiratory Institute, 9500 Euclid Ave, A90, Cleveland Clinic Foundation, Cleveland OH 44195; e-mail: amit.banga@gmail.com


This work was presented at Chest 2013, October 28, 2013, Chicago, IL, and was recognized with the Young Investigator Award.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(3):590-599. doi:10.1378/chest.14-0191
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BACKGROUND:  There are few data on characteristics and outcomes among patients with lung transplantation (LT) requiring admission to the medical ICU (MICU) beyond the perioperative period.

METHODS:  We interrogated the registry database of all admissions to the MICU at Cleveland Clinic (a 53-bed closed unit) to identify patients with history of LT done > 30 days ago (n = 101; mean age, 55.4 ± 12.6 years; 53 men, 48 women). We collected data regarding demographics, history of bronchiolitis obliterans syndrome, preadmission FEV1, clinical and laboratory variables at admission, MICU course, length of stay, hospital survival, and 6-month survival.

RESULTS:  The most common indication for MICU admission was acute respiratory failure (n = 51, 50.5%). Infections were most frequently responsible for respiratory failure, whereas acute rejection (cellular or humoral) was less likely (16%). Nearly one-fourth of the patients required hemodialysis (24.1%), and more than one-half required invasive mechanical ventilation (53.5%). Despite excellent hospital survival (88 of 101), 6-month survival was modest (56.4%). APACHE (Acute Physiology and Chronic Health Evaluation) III score at admission and single LT were independent predictors of hospital survival but did not predict outcome at 6 months. Functional status at discharge was the only independent predictor of 6-month survival (adjusted OR, 5.1; 95% CI, 1.1-22.7; P = .035).

CONCLUSIONS:  Acute rejection is an infrequent cause of decompensation among patients with LT requiring MICU admission. For patients admitted to the MICU, 6-month survival is modest. Functional status at the time of discharge is an independent predictor of survival at 6 months.

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