Transplantation: Transplantation |

Immediate and Underlying Causes of Death in Lung Transplant Recipients With and Without Chronic Lung Allograft Dysfunction FREE TO VIEW

Nishanth Yogarajah; Bart Vrugt, MD; Lars Huber, MD; Christian Benden, MD; Macé Schuurmans, MD
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Pulmonology, University Hospital Zurich, Zurich, Switzerland

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A601. doi:10.1016/j.chest.2016.02.628
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SESSION TITLE: Transplantation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: Chronic allograft dysfunction (CLAD) and infection have been considered the leading causes of death (COD) in lung transplant recipients (LTR). There are few studies addressing the COD in LTR and most report autopsy-verified postmortem diagnoses in less than 50% of the cases. In our setting practically all LTR have a lifelong close follow up care provided by our transplant center meaning that the end of life phase of these LTR occurs at our center as well. Therefore detailled follow-up data at time of death is included in our cohort database. The objective of this study is to evaluate immediate and underlying COD and CLAD frequency at time of death in a LTR cohort with close follow up data and a high rate of autopsies.

METHODS: Deaths in LTR between 2008 and 2013 were identified in our single center LTR cohort database. Medical records including lung function and imaging information, and when available autopsy reports, were analysed to determine the immediate and underlying COD and evidence of CLAD.

RESULTS: Mean survival was 4.6 years of 97 LTR who died in 2008 to 2013. 55 had an autopsy (57%) and 56 had CLAD (58%). The main immediate COD were respiratory failure (27/97), palliative care/therapy withdrawal (16), multi-organ failure (13), sepsis (9), and hemorrhage (8). The main underlying COD were graft failure/CLAD (35/97), malignancy (excluding posttransplant lymphoproliferative disease) (12), infection (11), cardiac disease (10), and renal failure (8).

CONCLUSIONS: Although more than half the LTR had a diagnosis of CLAD at time of death, CLAD was considered the underlying cause of death in only 1/3 of all patients. Malignancy, infection and cardiac disease were other important conditions leading to death in this cohort.

CLINICAL IMPLICATIONS: The diagnosis of CLAD increases the odds of dying of this condition, but there are a relevant number of patients with CLAD who die of other causes. Early detection and management of malignancy, infection and cardiac disease may contribute to improving long-term survival in LTR.

DISCLOSURE: The following authors have nothing to disclose: Nishanth Yogarajah, Bart Vrugt, Lars Huber, Christian Benden, Macé Schuurmans

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