Lung graft dysfunction in the early postoperative period after lung and heart lung transplantation.
BACKGROUND
We present a retrospective study of 9 years of experience in the management of graft dysfunction in the early postoperative period after lung transplantation (LT) and heart lung transplantation (HLT).


METHODS
There were 190 LT and HLT (22.63% single LT, 71.05% bilateral sequential LT, and 7.36% HLT) performed from 1993 to 2002. Hemodynamic and respiratory parameters were monitored during the operative technique and critical care for the first 24 hours. We analyzed ischemic time, bypass need, and type of transplant.


RESULTS
Lung graft dysfunction occurred in 37.2% of patients, but only in 12.2% was it severe. Nearly all patients were ventilated on a 50% fraction of inspired oxygen during the first 24-48 hours; 61.56% of patients were extubated before the first 5 postoperative day and 38.43% thereafter. The mean ischemia time for the first lung was 220 +/- 28 minutes: for the second lung, it was 378 +/- 31 minutes. The anesthetic time was 500-600 minutes. The variables associated with a significantly increased graft dysfunction were as follows: bilateral LT, and cardiopulmonary bypass requirement. The residence in the intensive care unit (ICU) was longer for patients with graft dysfunction than for those without that problem. Mortality directly related to graft dysfunction was only 4.07%.


CONCLUSIONS
A correlation among graft ischemia and early postoperative morbidity and duration of ICU stay did not have a significant impact on mortality.
Guillén
R Vicente
RV
Department of Anaesthesia and Critical Care, Hospital Universitario La Fe, Valencia, Spain. rosariovicenteg@vodafone.es
Briones
F Ramos
FR
Marín
P Morales
PM
Jover
A Solé
AS
Represa
J M Loro
JM
Colom
A Pastor
AP
D016041:Heart-Lung Transplantation / Q000401:mortality / Q000502:physiology*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation / Q000401:mortality / Q000502:physiology*; D011183:Postoperative Complications / Q000145:classification; D011184:Postoperative Period; D012189:Retrospective Studies; D016019:Survival Analysis