Prognosis factors in lung transplant recipients readmitted to the intensive care unit

Introduction

The short-term survival after lung transplantation has improved gradually. Despite this the peritransplant period is of high risk. Factors influencing the readmission of lung transplant recipients to the ICU are diverse, but respiratory failure and sepsis are the predominant causes. The objective of our study was to identify outcome predictors and prognostic factors for survival among lung transplant recipients on readmission to the ICU.

Materials and methods

A retrospective study of all lung transplant recipients achieved during a 10-year period (from 1997 to 2006). Data collection included the age, gender, reason for and type of lung transplantation. Variables specific to individual ICU admissions included the admission diagnosis, length of stay, duration of mechanical ventilation, interval time from transplantation, Acute Physiology and Chronic Health Evaluation (APACHE) II score on ICU admission, and the identification of systemic organ dysfunction. We used Student's t test (or, where appropriate, its nonparametric equivalent) or the χ² test for comparisons among the patients who died and the patients who survived their ICU admissions.

Results

A total of 144 lung transplants were performed at our institution. Forty-six of them died on the ICU during the immediate perioperative period. Finally, 98 were discharged from the ICU. Twenty-eight patients were readmitted to the ICU after discharge (28.57%). The mean of age was 51.3 ± 11.6 years. The male/female ratio was 23/5. The mean period transcurred between ICU discharge and ICU readmission was 107 ± 162 days. The admission diagnosis was sepsis in 20 cases (71.4%). Seventeen patients died during the ICU stay (60.7%). We found that an increase in APACHE II score, delay to ICU readmission, need of mechanical ventilation and three or more organ dysfunctions were significantly associated with mortality.

Conclusion

Admission to the ICU is common in lung transplant recipients, and it is associated with a high mortality. Sepsis is the main cause of ICU readmission and the most frequent cause of death. Lung transplant recipients with higher APACHE II score and three or more organ dysfunction present higher mortality. The delay on ICU readmission is also associated with higher mortality.