High donor age, low donor oxygenation, and high recipient inotrope requirements predict early graft dysfunction in lung transplant recipients.
BACKGROUND
Early dysfunction in lung transplants is characterized by poor oxygenation, which may then lead to prolonged mechanical ventilation. This may be due to a combination of donor, recipient, and management factors. Our aim was to determine the incidence and severity of hypoxia and graft dysfunction and which factors were directly associated with poor oxygenation within the first 24 hours after lung transplantation.


METHODS
A retrospective study of all 128 lung transplants between 1999 and 2002 was undertaken. Multiple linear regression analysis was performed to determine which donor, recipient, operative, and intensive care unit (ICU) parameters were associated with the worst recorded arterial blood gas partial pressure of oxygen (PAO2)/fraction of inspired oxygen (FIO2) ratio in the initial 24 hours after operation.


RESULTS
Eighty-three percent of the patients (104 of 128) had a PAO2/FIO2 ratio below 300 within the first 24 hours post-transplantation, and 60% (77 of 128) had a PAO2/FIO2 ratio below 200. A high donor age (p = 0.004), low donor PAO2 (p = 0.007), and high post-operative inotrope requirements (p = 0.02) were correlated with a low PAO2/FIO2 ratio. Recipient diagnosis, ischemic time, use of cardiopulmonary bypass, fluid balance in the ICU, and cardiac index were not related. There was no difference in the long-term outcomes of patients with high or low PAO2/FIO2 ratios.


CONCLUSIONS
A low PAO2/FIO2 ratio is a common finding in the first 24 hours after lung transplantation. Donor factors such as age and PAO2, and the need for increasing inotrope requirements in ICU predict early graft dysfunction and hypoxia.
Pilcher
David V
DV
Department of Intensive Care Medicine, The Alfred Hospital, Prahran, Victoria, Australia. dvpilcher@doctors.org.uk
Snell
Gregory I
GI
Scheinkestel
Carlos D
CD
Bailey
Michael J
MJ
Williams
Trevor J
TJ
D018806:APACHE; D000367:Age Factors; D002316:Cardiotonic Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology; D016014:Linear Models; D016040:Lung Transplantation / Q000502:physiology; D008297:Male; D015999:Multivariate Analysis; D010100:Oxygen / Q000097:blood*; D011184:Postoperative Period; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014019:Tissue Donors; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D010100:Oxygen