title: Course of illness after the onset of chronic rejection in lung transplant recipients.
abstract: BACKGROUND
  Despite the overall negative impact of chronic rejection on quality of life and survival after lung transplant, the specific clinical indicators of deterioration have not been identified.
  
  
  OBJECTIVE
  To describe the course of illness after the onset of chronic rejection, including demographic and transplant variables, morbidity, mortality, health resource utilization, and end-of-life care, and to identify clinical indicators of deterioration in health and limited survival after the onset of chronic rejection.
  
  
  METHODS
  The medical records of 311 recipients of lung transplants between 1998 and 2004 were reviewed retrospectively to identify 60 recipients who experienced chronic rejection.
  
  
  RESULTS
  Median survival after chronic rejection was 31.34 months. Time to rejection (mean, 26.05 months; SD, 16.85) was significantly correlated with overall survival without need of a retransplant (r = 0.64; P < .001). The earlier the onset of chronic rejection or the need for oxygen at home, the shorter was the period of survival after chronic rejection and the more frequent were hospital and intensive care unit admissions and prolonged stays. Of the 26 recipients who died, 65% died at the transplant center, and all but 1 died in the intensive care unit; 3 died after multiple attempts of cardiopulmonary resuscitation; life support was ultimately withdrawn in 69%.
  
  
  CONCLUSIONS
  Lung transplant recipients who experience chronic graft rejection have high rates of morbidity, mortality, and health resource utilization; however, the course of illness after chronic rejection is highly variable.
authors.affiliation: School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, Chapel Hill, NC 27599-7460, USA. songm@email.unc.edu
authors.forename: Mi-Kyung
authors.initials: MK
authors.lastname: Song
authors.forename: Annette
authors.initials: A
authors.lastname: De Vito Dabbs
authors.forename: Sean M
authors.initials: SM
authors.lastname: Studer
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Zangle
mesh_terms: D002908:Chronic Disease; D003710:Demography; D005260:Female; D006084:Graft Rejection / Q000401:mortality* / Q000503:physiopathology*; D006296:Health Services / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D016019:Survival Analysis; D013727:Terminal Care / Q000706:statistics & numerical data*; D013997:Time Factors