Perioperative Complications of Lung Transplantation in Patients With Emphysema and Fibrosis: Experience From 1992–2002

Abstract

Our objective was to describe the incidence of perioperative complications of lung transplantation among patients with emphysema and fibrosis and the morbidity and mortality risk factors. Materials and Methods We performed a retrospective study of 111 lung transplant patients engrafted from 1992 to 2002 for emphysema ( n = 65) or lung fibrosis ( n = 46). This descriptive study included the most frequent complications during the perioperative period in the intensive care unit. Results The most frequent intraoperative complications were reperfusion syndrome, hemodynamic instability, and cardiac arrhythmias. Among patients with emphysema, the follow-up of postoperative complications proved statistically significant on univariate analysis for an association of patient mortality with prolonged intubation ( P = .005), rejection ( P = .0001), hemorrhage ( P = .0001), sepsis ( P = .0001), renal failure ( P = .001), and implantation response ( P = .014). Mortality among these patients was 16.9%. Mechanical ventilation for over 48 hours and postoperative hemorrhage were the variables with the greatest predictive value for mortality in the postoperative period. Among patients with fibrosis, the complication-related mortality were reperfusion syndrome ( P = .039), implantation response ( P = .039), renal failure ( P = .013), rejection ( P = .016), and sepsis ( P < .001). The mortality rate was 23.9% with sepsis ( P = .000) being the most frequent cause of death in the immediate postoperative period. Conclusions The most frequent intraoperative complications were reperfusion syndrome and hemodynamic instability. The most frequent postoperative complications were implantation response, sepsis, prolonged intubation, hemorrhage, and renal failure.