Does anaesthetic management affect early outcomes after lung transplant? An exploratory analysis.
BACKGROUND
Primary graft dysfunction (PGD) is a predominant cause of early morbidity and mortality after lung transplantation. Although substantial work has been done to understand risk factors for PGD in terms of donor, recipient, and surgical factors, little is understood regarding the potential role of anaesthetic management variables in its development.


METHODS
We conducted a retrospective exploratory analysis of 107 consecutive lung transplants to determine if anaesthesia factors were associated with early graft function quantified by Pa(O(2))/Fi(O(2)). Multivariate regression techniques were used to explore the association between anaesthetic management variables and Pa(O(2))/Fi(O(2)) ratio 12 h after operation. The relationship between these variables and both time to tracheal extubation and intensive care unit (ICU) length of stay was further examined using the Cox proportional hazards.


RESULTS
On multivariate analysis, increasing volume of intraoperative colloid, comprising predominantly Gelofusine (succinylated gelatin), was independently associated with a lower Pa(O(2))/Fi(O(2)) 12 h post-transplantation [beta coefficient -42 mm Hg, 95% confidence interval (CI) -7 to -77 mm Hg, P=0.02] and reduced rate of extubation [hazard ratio (HR) 0.65, 95% CI 0.49-0.84, P=0.001]. There was a trend for intraoperative colloid to be associated with a reduced rate of ICU discharge (HR 0.79, 95% CI 0.31-1.02, P=0.07).


CONCLUSIONS
We observed an inverse relationship between volume of intraoperative colloid and early lung allograft function. The association persists, despite detailed sensitivity analyses and adjustment for potential confounding variables. Further studies are required to confirm these findings and explore potential mechanisms through which these associations may act.
McIlroy
D R
DR
Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia. dm2655@columbia.edu
Pilcher
D V
DV
Snell
G I
GI
D000293:Adolescent; D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D002648:Child; D020878:Device Removal; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007430:Intraoperative Care / Q000009:adverse effects; D007442:Intubation, Intratracheal / Q000295:instrumentation; D007902:Length of Stay / Q000706:statistics & numerical data; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000009:adverse effects; D011097:Polygeline / Q000008:administration & dosage / Q000009:adverse effects; D011184:Postoperative Period; D055031:Primary Graft Dysfunction / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
D010952:Plasma Substitutes; D011097:Polygeline; D010100:Oxygen