title: Prevalence, Cause, and Treatment of Respiratory Insufficiency After Orthotopic Heart Transplant.
abstract: OBJECTIVE
  Heart transplant is the best treatment for end-stage heart failure. Respiratory insufficiency after heart transplant is a potentially serious complication. Pulmonary complications, pulmonary hypertension, allograft failure or rejection, and structural heart defects in the donor heart are among the causes of hypoxemia after transplant. In this study, we evaluated the prevalence of hypoxemia and respiratory insufficiency in patients with orthotopic heart transplant during the early postoperative period.
  
  
  METHODS
  We retrospectively evaluated the medical records of 45 patients who had received orthotopic heart transplant at our center. Clinical and demographic variables and laboratory data were noted. Oxygen saturation values from patients in the first week and the first month after transplant were analyzed. We also documented the cause of respiratory insufficiency and the type of treatment.
  
  
  RESULTS
  Mean age was 35.3 ± 15.3 years (range, 12-61 y), with males comprising 32 of 45 patients (71.1%). Two patients had mild chronic obstructive pulmonary disease and 1 had asthma. Twenty-five patients (55.6%) had a history of smoking. Respiratory insufficiency was noted in 9 patients (20%) during the first postoperative week. Regarding cause, 5 of these patients (11.1%) had pleural effusion, 2 (4.4%) had atelectasis, 1 (2.2%) had pneumonia, and 1 (2.2%) had acute renal failure. Therapies administered to patients with respiratory insufficiency were as follows: 5 patients had oxygen therapy with nasal canula/mask, 3 patients had continuous positive airway pressure, and 1 patient had mechanical ventilation. One month after transplant, 2 patients (4.4%) had respiratory insufficiency 1 (2.2%) due to pleural effusion and 1 (2.2%) due to atelectasis.
  
  
  CONCLUSIONS
  Respiratory insufficiency is a common complication in the first week after orthotopic heart transplant. Identification of the underlying cause is an important indicator for therapy. With appropriate care, respiratory insufficiency can be treated successfully.
authors.affiliation: From the Department of Pulmonary Disease, Baskent University Faculty of Medicine, Ankara, Turkey 06490.
authors.forename: Şerife
authors.initials: Ş
authors.lastname: Savaş Bozbaş
authors.forename: Gaye
authors.initials: G
authors.lastname: Ulubay
authors.forename: Füsun
authors.initials: F
authors.lastname: Öner Eyüboğlu
authors.forename: Atilla
authors.initials: A
authors.lastname: Sezgin
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology; D002648:Child; D045422:Continuous Positive Airway Pressure; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D010996:Pleural Effusion / Q000453:epidemiology / Q000628:therapy; D015995:Prevalence; D001261:Pulmonary Atelectasis / Q000453:epidemiology / Q000628:therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult