Does reperfusion injury still cause significant mortality after lung transplantation?
OBJECTIVE
Severe reperfusion injury after lung transplantation has mortality rates approaching 40%. The purpose of this investigation was to identify whether our improved 1-year survival after lung transplantation is related to a change in reperfusion injury.


METHODS
We reported in March 2000 that early institution of extracorporeal membrane oxygenation can improve lung transplantation survival. The records of consecutive lung transplant recipients from 1990 to March 2000 (early era, n = 136) were compared with those of recipients from March 2000 to August 2006 (current era, n = 155). Reperfusion injury was defined by an oxygenation index of greater than 7 (where oxygenation index = [Percentage inspired oxygen] x [Mean airway pressure]/[Partial pressure of oxygen]). Risk factors for reperfusion injury, treatment of reperfusion injury, and 30-day mortality were compared between eras by using chi(2), Fisher's, or Student's t tests where appropriate.


RESULTS
Although the incidence of reperfusion injury did not change between the eras, 30-day mortality after lung transplantation improved from 11.8% in the early era to 3.9% in the current era (P = .003). In patients without reperfusion injury, mortality was low in both eras. Patients with reperfusion injury had less severe reperfusion injury (P = .01) and less mortality in the current era (11.4% vs 38.2%, P = .01). Primary pulmonary hypertension was more common in the early era (10% [14/136] vs 3.2% [5/155], P = .02). Graft ischemic time increased from 223.3 +/- 78.5 to 286.32 +/- 88.3 minutes in the current era (P = .0001). The mortality of patients with reperfusion injury requiring extracorporeal membrane oxygenation improved in the current era (80.0% [8/10] vs 25.0% [3/12], P = .01).


CONCLUSIONS
Improved early survival after lung transplantation is due to less severe reperfusion injury, as well as improvements in survival with extracorporeal membrane oxygenation.
Ailawadi
Gorav
G
Department of Surgery, University of Virginia, Charlottesville, VA 22908-0679, USA.
Lau
Christine L
CL
Smith
Philip W
PW
Swenson
Brian R
BR
Hennessy
Sara A
SA
Kuhn
Courtney J
CJ
Fedoruk
Lynn M
LM
Kozower
Benjamin D
BD
Kron
Irving L
IL
Jones
David R
DR
D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015427:Reperfusion Injury / Q000453:epidemiology*; D012720:Severity of Illness Index; D015996:Survival Rate