title: [Perioperative mortality of lung transplantation in chronic obstructive pulmonary disease].
abstract: BACKGROUND
  Lung transplantation (LT) has been considered an alternative therapeutic approach in terminal patients. However, this process in COPD is not controversy-free. This paper aimed to analyze 30-day mortality (PM) patterns and their risk factors in COPD patients undergoing LT.
  
  
  METHODS
  A retrospective cohort with 107 COPD patients, transplanted at the University La Fe Valencia, Spain, treated from January 1991 to December 2008. Demographics values, degree of dyspnoea, diagnosis, BODE index, single versus bilateral LT, cardio-pulmonary bypass, donor age, steroid dependence, presence of bronchiectasis, retrograde perfusion, transfusion of blood products, and PaO2/FiO2 were analyzed. Continuous variables were expressed as mean±SD and categorical variables as absolute frequency and percentage. A Cox regression model was used for multivariate analysis.
  
  
  RESULTS
  Ninety-four men and 13 women of a mean age of 52.58±8.05 years were transplanted. Of all patients, 75% obtained a BODE score above 7. There were 76 bilateral LT. PM was established at 14%. Main causes of death were infection (53.3%) and surgical complications (33.3%). Presence of bronchiectasis and chronic use of corticosteroids, donor/recipient difference in size and presence of fat in retrograde perfusion fluid were important risk factors for PM. Moreover, PaO2/FiO2 ratio at 6h was a protective factor for the event, thus a higher ratio value, lowered the risk of PM.
  
  
  CONCLUSIONS
  LT is a procedure with a high PM rate. Use of corticosteroids, the presence of bronchiectasis and fat emboli in the retrograde reperfusion, and PaO2/FiO2 significantly determine PM.
authors.affiliation: Servicio de Cirugía Torácica, Hospital Universitario y Politécnico La Fe, Valencia, España. Electronic address: ceronjs@yahoo.es.
authors.forename: José
authors.initials: J
authors.lastname: Cerón Navarro
authors.affiliation: Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología (IVO), Valencia, España.
authors.forename: Karol
authors.initials: K
authors.lastname: de Aguiar Quevedo
authors.affiliation: Servicio de Cirugía Torácica, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Jordá Aragón
authors.affiliation: Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología (IVO), Valencia, España.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Peñalver Cuesta
authors.affiliation: Servicio de Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: Nuria
authors.initials: N
authors.lastname: Mancheño Franch
authors.affiliation: Servicio de Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: Francisco
authors.initials: F
authors.lastname: Vera Sempere
authors.affiliation: Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología (IVO), Valencia, España.
authors.forename: José
authors.initials: J
authors.lastname: Padilla Alarcón
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Chronic pulmnary obstructive disease; Enfermedad pulmonar obstructiva crónica; Lung transplantation; Mortalidad perioperatoria; Perioperative mortality; Trasplante pulmonar