Transplantation |

Lung Transplantation for Emphysema: Is There Something New in Mortality Risk Factors? FREE TO VIEW

Daniel Valdivia; Lucas Hoyos; Lidia Macias; David Gomez; Rosalia Laporta; Jose Luis Campo; Andres Varela
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Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

Chest. 2014;146(4_MeetingAbstracts):983A. doi:10.1378/chest.1989764
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SESSION TITLE: Lung Transplantation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Emphysema is the most common indication for lung transplantation. We aim to review the results of our experience in a 5 year period and to identify risk factors for mortality.

METHODS: A retrospective analysis was undertaken of the 63 consecutive lung transplants for emphysema performed in our institution between 2005 and 2010. Follow up was complete and averaged 2.9 years.

RESULTS: Mean age of recipients was 56.7 (+/-8 years). Recipient’s diagnoses were: 56 (88.9%) chronic obstructive pulmonary disease, 6 (9.5%) alpha 1 antitrypsin deficiency and 1 (1.6%) cutis laxa syndrome. Brain death donors represented 53 (84.1%) and non-heart beating donors 10 (15.9%). Ex-Vivo assessment was performed in 6 cases (9.5%). Bilateral procedures were performed in 37 (58.7%) patients. Cardiopulmonary bypass was required in 14 (22.2%) cases, mainly due to secondary pulmonary hypertension (12, 85.7%). Time to extubation was less than 48 hours in 36 (57.1%) patients. Most common complications were acute rejection (24, 38.1%), cardiovascular (22, 34.9%), primary graft disfunction (PGD) (20, 31.7%), pleuro-pulmonary (16, 25.4%), drug-related (15, 23.8%) and infections 14 (22.2%). The frequency of chronic lung allograft dysfunction (CLAD) at 1, 3 and 5 years was 3.2%, 14.3% and 6.3%, respectively. Bilateral lung transplantation was associated with less presence of CLAD (p<0.004). Overall survival at 1, 3 and 5 years was 77.8%, 68.9% and 58.6%, respectively. Forced expiratory volume in 1 second (FEV1) improved (p<0.001) and seems to stabilize after 6 months of the transplantation. Univariate analysis showed that body mass index greater than 25 (p<0.025), grade 3 PGD (p< 0.006) and non-heart beating donors (p<0.013) are associated with a higher mortality.

CONCLUSIONS: Bilateral lung transplantation for emphysema results in less presence of CLAD. Body mass index greater than 25, grade 3 PGD and non-heart beating donors, are risk factors for mortality.

CLINICAL IMPLICATIONS: Provide data about mortality risk factors in a group of patients where lung transplantation has evolved in the last decade

DISCLOSURE: The following authors have nothing to disclose: Daniel Valdivia, Lucas Hoyos, Lidia Macias, David Gomez, Rosalia Laporta, Jose Luis Campo, Andres Varela

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