Influence of underlying lung disease on early postoperative course after single lung transplantation.
BACKGROUND
Single lung transplantation can be a suitable therapeutic option for a wide range of end-stage lung diseases: pulmonary fibrosis, emphysema, primary pulmonary hypertension and Eisenmenger's syndrome. Yet, patients suffering from different diseases have significantly different cardiovascular and respiratory functional profiles that can exert a profound influence on their response to the perioperative procedures. Our purpose is to analyze whether the patient's underlying disease can influence the early postoperative outcome after single lung transplantation.


METHODS
We carried out a retrospective analysis on perioperative charts of patients undergoing single lung transplantation during an 8-year period. We focused our attention on the following data: underlying lung disease, age, sex, baseline cardiorespiratory data (pulmonary artery pressure, cardiac index, forced expired volume, vital capacity, arterial blood gases, body mass index), intraoperative data (duration of graft ischemia, use of cardiopulmonary bypass) and indexes of adverse postoperative outcome (in-hospital death, mechanical ventilatory support >7 days). Patients were gathered in 3 groups (restrictive, obstructive and vascular) according to the kind of disease and functional data and the association between disease and outcome was assessed by means of logistic regression analysis. Moreover, we evaluated whether any of the patient's functional parameters could be considered predictive of adverse postoperative outcome.


RESULTS
We observed a weak association between restrictive disease and adverse postoperative outcome while, on the other hand, obstructive and vascular forms showed a close association with an adverse outcome, with a borderline statistical significance. Among all the considered variables, only intraoperative use of CPB turned out to be predictive of adverse outcome, while other variables simply indicated a trend towards a better outcome.


CONCLUSIONS
Patients with vascular and obstructive diseases have the worst postoperative course, with a higher in-hospital mortality rate and longer duration of ventilation; in particular, the perioperative course of vascular patients is heavily influenced by the intraoperative use of cardiopulmonary bypass.
Ceriana
P
P
Respiratory Intensive Care Unit, IRCCS, S. Maugeri Foundation, Medical Centre of Pavia, Italy.
Klersy
C
C
Veronesi
R
R
Braschi
A
A
D'Armini
A
A
Viganò
M
M
D000328:Adult; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation / Q000401:mortality* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome