Analysis of Perioperative Factors Leading to Postoperative Pulmonary Complications, Graft Injury and Increased Postoperative Mortality in Lung Transplantation

Abstract

ObjectivesPostoperative complications such as postoperative pulmonary complications (PPC) and other organ complications are associated with increased morbidity and mortality after successful lung transplantation and have a detrimental effect on patient recovery. The aim of this study was to investigate perioperative risk factors for in-hospital mortality and postoperative complications with a focus on PPC and graft injury in patients undergoing lung transplantation DesignSingle-center retrospective cohort study of 173 patients undergoing lung transplantation SettingUniversity Hospital, Medical Center Freiburg Main ResultsIn the stepwise multivariate regression analysis, donor age >60 years (OR 1.85, 95% CI 1.27-2.81), intraoperative ECMO (OR 2.4, 95% CI 1.7-3.3), transfusion of > 4 red blood cell concentrates (OR 3.1, 95% CI 1.82-5.1), mean pulmonary artery pressure > 30 mmHg at the end of surgery (OR 3.5, 95% CI 2-6.3), the occurrence of postoperative graft injury (OR 4.1, 95% CI 2.8-5.9), PPCs (OR 2.1, 95% CI 1.7-2.6), sepsis (OR 4.5, 95% CI 2.8-7.3) and acute renal failure KDIGO 3 (OR 4.3, 95% CI 2.4-7.7) were associated with increased in hospital mortality, while COPD patients had a lower in-hospital mortality (OR 1.6, 95% CI 1.4-1.9). The frequency and number of PPC correlated with postoperative mortality. ConclusionClinical management and risk stratification focusing on the underlying, identified factors could help improve patients’ outcome.