title: Outcome of lung transplant recipients requiring readmission to the intensive care unit.
abstract: BACKGROUND
  Lung transplantation is the recognized therapy for end-stage respiratory failure. Many serious medical complications have been described occurring from months to years after lung transplantation, often necessitating admission to an intensive care unit (ICU). We examined the factors associated with death.
  
  
  METHODS
  All consecutive lung transplant recipients who were readmitted to the ICU > 30 days after transplantation from 2000 to 2009 were included in this retrospective study. Data were collected regarding demographic parameters, ICU stay, and outcome.
  
  
  RESULTS
  During the study period, 40 patients were admitted to the ICU. The main pre-transplant diagnosis was idiopathic pulmonary fibrosis, followed by chronic obstructive pulmonary disease. Most patients (93%) required mechanical ventilation during their ICU stay. The main reason for ICU admission was septic shock in 22 patients (55%). An organism was isolated from 19 of these patients; in 11 patients, the organism was multidrug resistant. The ICU mortality was 62.5%. Non-survivors were characterized by more frequent readmissions to hospital (p = 0.02), a higher admission Sequential Organ Failure Assessment score (p = 0.02), an admission diagnosis of sepsis (87.5% vs 37.5% for all other diagnoses, p < 0.001), and a requirement for mechanical ventilation (p = 0.02). The incidence of bronchiolitis obliterans syndrome was also significantly higher in non-survivors (p = 0.02).
  
  
  CONCLUSIONS
  Severe sepsis remains the most important factor associated with a poor outcome after readmission to ICU. New strategies are required to alter the course of this common complication of lung transplantation.
authors.affiliation: Department of General Intensive Care, Tel Aviv University, Tel Aviv, Israel. jdcspc@gmail.com
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cohen
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
authors.forename: Yael
authors.initials: Y
authors.lastname: Raviv
authors.forename: Ilana
authors.initials: I
authors.lastname: Bakal
authors.forename: David
authors.initials: D
authors.lastname: Shitrit
authors.forename: Shaul
authors.initials: S
authors.lastname: Lev
authors.forename: Mordechai R
authors.initials: MR
authors.lastname: Kramer
mesh_terms: D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000453:epidemiology; D018432:Drug Resistance, Multiple; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery; D011658:Pulmonary Fibrosis / Q000601:surgery; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D016896:Treatment Outcome