Influence of lung injury on early postoperative survival after lung transplantation.
OBJECTIVE
To identify the various risk factors for early (90 day) mortality after lung transplantation and to evaluate the relationship between lung injury and postoperative survival.


METHODS
152 recipients of single (100) or bilateral (52) lung allografts were evaluated for the presence of postoperative lung injury assessed by a composite four-component lung injury score. Preoperative variables, postoperative course, and mortality were reviewed retrospectively.


RESULTS
There was a high risk of death during the first 90 d after transplantation, followed by a decline in risk during the remainder of the first postoperative year. By univariate analysis, lung injury score (p = 0.0001), chest radiograph score (p = 0.0001), and hypoxemia (PaO2/FIO2) ratio (p = 0.0002) were the most statistically significant risk factors for 90-day mortality. Other parameters such as length of intensive care stay (p = 0.0175), length of intubation (p = 0.0212), and preoperative diagnosis of pulmonary fibrosis (p = 0.0123) were also significant risk factors for 90-day mortality. By multivariable analysis, only lung injury score (p = 0.0001) was a statistically significant risk factor for 90-day mortality. The risk of 90-day mortality increased by a factor of 4.4 for each 1 point increment in lung injury score. However, none of the analyzed preoperative or postoperative variables were able to statistically predict lung injury score.


CONCLUSIONS
Postoperative lung injury is the most important risk factor for early postoperative mortality after lung transplantation.
Schulman
L L
LL
Department of Medicine, College of Physicians & Surgeons of Columbia University, New York, New York 10032, USA. LLS2@columbia.edu
Weinberg
A D
AD
McGregor
C C
CC
Galantowicz
M E
ME
Smith
C R
CR
D000328:Adult; D005260:Female; D006801:Humans; D055370:Lung Injury; D016040:Lung Transplantation / Q000401:mortality* / Q000473:pathology / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors