Respiratory Failure after TX

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(Chest. 2003;123:165-173.)

© 2003 American College of Chest Physicians

c

Wissam M. Chatila, MD, FCCP; Satoshi Furukawa, MD;

P. Gaughan, PhD and Gerard J. Criner, MD, FCCP

* From the Division of Pulmonary and Critical Care

Medicine, (Drs. Chatila and Criner), Department of

Medicine; Cardiothoracic Division (Dr. Furukawa),

Department of Surgery; and Department of Biostatistics

(Dr. Gaughan), Temple University School of Medicine,

Philadelphia, PA.

Correspondence to: Wissam Chatila, MD, FCCP, Assistant

Professor of Medicine, Division of Pulmonary and

Critical Care Medicine, 763 PP, Temple University

School of Medicine, 3401 N Broad St, Philadelphia, PA

19140; e-mail: chatilw@...

Study objectives: To characterize patients who

acquired postoperative respiratory failure after lung

transplantation (LT), and to identify risks associated

with postoperative respiratory failure and poor

surgical outcome.

Study design: Retrospective clinical analysis in a

tertiary care transplantation center.

Methods: We reviewed the records of 80 consecutive

patients who underwent LT from April 1994 to May 1999,

analyzing their records for a number of preoperative

and perioperative variables and complications.

Results: Forty-four patients (55%) acquired

postoperative respiratory failure and had a mortality

rate of 45%. No difference was noted between patients

with respiratory failure and those without in terms of

age (mean ± SD, 56 ± 9 years vs 53 ± 11 years),

gender, baseline pretransplant arterial blood gas

analysis (PaCO2, 46 ± 9 mm Hg vs 44 ± 10 mm Hg), and

cardiopulmonary exercise testing (maximum oxygen

uptake, 0.76 ± 0.44 L/min/m2 vs 0.82 ± 0.20 L/min/m2).

Ischemic reperfusion lung injury (IRLI) [55%] and

perioperative cardiovascular/hemorrhagic events (36%)

were the major contributors to the development of

respiratory failure. Preoperative pulmonary

hypertension, right ventricular (RV) dysfunction,

ischemic times, and need for bilateral LT and

cardiopulmonary bypass (CPB) were higher in patients

with respiratory failure (p < 0.05) compared to

recipients without respiratory failure. However, the

presence of preoperative moderate-to-severe RV

dysfunction was the only independent factor (odds

ratio, 21.9; 95% confidence interval, 1.6 to 309.0).

Conclusion: Respiratory failure after LT is common and

is associated with high morbidity and mortality.

Respiratory failure often occurred in patients with

operative technical complications, cardiovascular

events, and postoperative IRLI, which were observed

most in patients requiring CPB because of RV

dysfunction.

Key Words: cardiopulmonary bypass •

ischemia-reperfusion injury • lung transplantation •

pulmonary hypertension • respiratory failure • right

ventricular dysfunction

Becki

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