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Vol. 39. Issue 8.
Pages 353-360 (August 2003)
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Vol. 39. Issue 8.
Pages 353-360 (August 2003)
Prognostic Factors of Morbidity and Mortality in the Early Postoperative Period Following Lung Transplantation
Factores pronósticos de morbimortalidad en el postoperatorio inmediato del trasplante pulmonar
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FJ. Gómeza, A. Planasa, P. Ussettib, JJ. Tejadaa, A. Varelac
a Servicio de Anestesiología y Reanimación. Hospital Universitario Clínica Puerta de Hierro. Madrid. Spain.
b Servicio de Neumología. Hospital Universitario Clínica Puerta de Hierro. Madrid. Spain.
c Servicio de Cirugía Torácica. Hospital Universitario Clínica Puerta de Hierro. Madrid. Spain.
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Tables (5)
TABLE 1. Preoperative recipient variables
TABLE 2. Causes of death in the postoperative recovery unit
TABLE 3. Variables associated with mortality in the postoperative recovery unit
TABLE 4. Variables associated with early graft dysfunction
TABLE 5. Postoperative hemodynamic evolution in patients with and without early graft dysfunction
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Objectives: Despite years of experience with lung transplantation, the rate of perioperative mortality remains high. The objective of this study was to look at our experience in the early postoperative period following lung transplantation in an effort to identify possible pre-, intra- and postoperative risk factors associated with mortality. Patients and methods: A retrospective study of 68 consecutive patients receiving lung transplants over a period of 56 months. The conditions that led to transplantation were obstructive disease (40%), interstitial disease (33%) and suppurative disease (27%). Pre-, intra- and postoperative characteristics of donors and recipients were analyzed for their relation to morbidity and mortality. Statistical studies were done using SPSS 10.0 software. A p-value less than .05 was considered significant. Univariate analysis identified variables associated with the incidence of mortality in the postoperative recovery unit, and the variables with statistically significant associations were entered into multivariate analysis, using a logistic regression model to calculate odds ratio (OR) and 95% confidence intervals (CI). Results: No donor variables correlated with mortality. Patients with suppurative lung disease had a lower mortality rate (0% vs 30%; P=.04). Mortality was related to ischemic time longer than 300 minutes (OR = 2) and the use of extracorporeal circulation (OR = 4). A PaO2/FiO2 ratio less than 150 during the first 24 hours following transplantation (OR = 5) and reoperation due to bleeding (OR = 12) were the variables showing the highest correlations with mortality during the early postoperative period. Conclusions: The mortality rate during the early postoperative period in our series was 22%. The survival rate was better in patients with suppurative lung disease. Bleeding that required reoperation and early graft dysfunction (defined in part by a PaO2/FiO2 ratio less than 150 during the first 24 hours) were the variables that best predicted death in the early postoperative period following lung transplantation.
Keywords:
Lung transplantation
Mortality
Early postoperative period
Prognostic variables
Objetivos: A pesar de la experiencia acumulada, la mortalidad perioperatoria del trasplante pulmonar (TP) continúa siendo elevada. El objetivo de este estudio es revisar nuestra experiencia en el postoperatorio inmediato del TP tratando de identificar las posibles variables pre, intra y postoperatorias asociadas a riesgo de mortalidad. Pacientes y métodos: Estudio retrospectivo de 68 pacientes sometidos de forma consecutiva a TP, durante un período de 56 meses. Las enfermedades que motivaron el TP fueron obstructiva (40%), intersticial (33%) y supurativa (27%). Se analizaron las variables relativas a los donantes y a los receptores (pre, intra y postoperatorias) relacionadas con la morbimortalidad. El estudio estadístico se realizó con el paquete informático SPSS, versión 10.0. Un valor de p inferior a 0,05 se consideró significativo. Se realizó un análisis univariante para identificar las variables asociadas con la incidencia de mortalidad en la unidad de reanimación. Las variables que presentaron significación estadística se sometieron a análisis multivariante, mediante modelo de regresión logística, para calcular la odds ratio (OR) y su intervalo de confianza (IC) del 95%. Resultados: Ninguna de las variables relativas al donante se relacionó con la mortalidad. Los pacientes con enfermedad supurativa presentaron menor mortalidad (el 0 frente al 30%; p = 0,04). El tiempo de isquemia superior a 300 min y la utilización de circulación extracorpórea presentaron OR de mortalidad de 2 y 4, respectivamente. La relación PaO2/FiO2 inferior a 150 en las primeras 24 h postrasplante (OR = 5) y la reintervención por hemorragia (OR = 12) fueron las variables con mayor relación con la mortalidad en el postoperatorio inmediato. Conclusiones: La mortalidad durante el postoperatorio inmediato en nuestra serie fue del 22%. Los pacientes con enfermedad supurativa presentaron una mayor supervivencia. La hemorragia que obliga a la reintervención y la disfunción temprana del injerto (definida en parte por la relación PaO2/FiO2 < 150 en las primeras 24 h) fueron las variables analizadas con mayor valor predictivo de mortalidad en el postoperatorio inmediato del TP.
Palabras clave:
Trasplante de pulmón
Mortalidad
Postoperatorio inmediato
Variables predictivas

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