Risk factors for reperfusion injury after lung transplantation.
OBJECTIVE
To assess the influence of recipient's and donor's factors as well as surgical events on the occurrence of reperfusion injury after lung transplantation.


METHODS
Retrospective study in the surgical intensive care unit (ICU) of a university hospital.


METHODS
We collected data on 60 lung transplantation donor/recipient pairs from June 1993 to May 2001, and compared the demographic, peri- and postoperative variables of patients who experienced reperfusion injury (35%) and those who did not.


RESULTS
The occurrence of high systolic pulmonary pressure immediately after transplantation and/or its persistence during the first 48 h after surgery was associated with reperfusion injury, independently of preoperative values. Reperfusion injury was associated with difficult hemostasis during transplantation (p=0.03). Patients with reperfusion injury were more likely to require the administration of catecholamine during the first 48 h after surgery (p=0.014). The extubation was delayed (p=0.03) and the relative odds of ICU mortality were significantly greater (OR 4.8, 95% CI: 1.06, 21.8) in patients with reperfusion injury. Our analysis confirmed that preexisting pulmonary hypertension increased the incidence of reperfusion injury (p<0.01).


CONCLUSIONS
Difficulties in perioperative hemostasis were associated with reperfusion injury. Occurrence of reperfusion injury was associated with postoperative systolic pulmonary hypertension, longer mechanical ventilation and higher mortality. Whether early recognition and treatment of pulmonary hypertension during transplantation can prevent the occurrence of reperfusion injury needs to be investigated.
Cottini
Silvia R
SR
Division of Surgical Intensive Care, Department of Anesthesiology, Pharmacology and Surgical Intensive Care, University Hospital of Geneva, Geneva, Switzerland. Silvia.Cottini@eoc.ch
Lerch
Nicolas
N
de Perrot
Marc
M
Treggiari
Miriam M
MM
Spiliopoulos
Anastase
A
Nicod
Laurent
L
Ricou
Bara
B
D000328:Adult; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D015427:Reperfusion Injury / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology