Outcome of critically ill lung transplant candidates on invasive respiratory support
- 422 Downloads
Lung transplantation (LTx) of patients on mechanical ventilation (MV) or extracorporeal support (ECS) is controversial because of impaired survival. Prognostic factors to predict survival should be identified.
A retrospective analysis was performed in a single centre of all ventilated LTx-candidates awarded an Eurotransplant (ET) high-urgency (HU) status between November 2004 and July 2009. Clinical data were collected on the first day of HU-status from intubated patients with an approved HU status. Single parameters as well as the lung allocation score (LAS), the Sequential Organ Failure Assessment score (SOFA) and the Simplified Acute Physiology Score (SAPS 2) were calculated. The association of these variables with survival was evaluated.
A total of 100 intubated patients (median age 38 years, 56 % female) fulfilled the inclusion criteria, of whom 60 also required ECS. The main indications were cystic fibrosis (25 %) and idiopathic pulmonary fibrosis (24 %). Median time with HU status was 12 days [interquartile range (IQR) 6–21 days]. Sixty patients were transplanted, five were weaned from mechanical ventilation and 38 died while on the wait list. One-year-survival rates were 57, 36 and 5 % for transplanted patients, all candidates and non-transplanted candidates, respectively (p < 0.001). A SAPS score >24 (median 30, IQR 27–35), a procalcitonin level of >0.5 µg/l (median 0.4, IQR 0.1–1.4 µg/l) and any escalation of bridging strategy were independently associated with mortality (p = 0.021, = 0.003, and < 0.001, respectively). The LAS (median 88, IQR 8–90) did not predict survival (p = 0.92).
High-urgency LTx improves survival in critically ill intubated candidates. Higher SAPS scores, escalating therapy and an abnormal procalcitonin level were associated with a poor outcome.
KeywordsLung transplantation Mechanical ventilation Ventilator weaning Patient selection Lung allocation score
This work was supported by a grant from the German Federal Ministry of Education and Research (reference number: 01EO0802). The contents of this article are the sole responsibility of the authors.
- 1.Christie JD, Edwards LB, Aurora P, Dobbels F, Kirk R, Rahmel AO, Stehlik J, Taylor DO, Kucheryavaya AY, Hertz MI (2009) The Registry of the International Society for Heart and Lung Transplantation: Twenty-sixth Official Adult Lung and Heart-Lung Transplantation Report—2009. J Heart Lung Transplant 28:1031–1049PubMedCrossRefGoogle Scholar
- 13.Internet Communication (2009) A guide to calculating the lung allocation score. Available at: http://www.unos.org/docs/lung_allocation_score.pdf
- 15.Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710PubMedCrossRefGoogle Scholar
- 18.Christie JD, Carby M, Bag R, Corris P, Hertz M, Weill D (2005) Report of the ISHLT Working Group on Primary Lung Graft Dysfunction part II: definition. A consensus statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 24:1454–1459PubMedCrossRefGoogle Scholar
- 21.Bullinger M (1996) Assessment of health related quality of life with the SF-36 Health Survey. Rehabilitation (Stuttg) 35:17–27Google Scholar
- 25.Orens JB, Estenne M, Arcasoy S, Conte JV, Corris P, Egan JJ, Egan T, Keshavjee S, Knoop C, Kotloff R, Martinez FJ, Nathan S, Palmer S, Patterson A, Singer L, Snell G, Studer S, Vachiery JL, Glanville AR (2006) International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 25:745–755PubMedCrossRefGoogle Scholar