Preliminary Report of the Safety and Efficacy of Hyperbaric Oxygen Therapy for Specific Complications of Lung Transplantation

Abstract

Lung transplantation (LTx) is a complex therapy requiring immunosuppression and is associated with significant infective morbidity and mortality. Hyperbaric oxygen (HBO) therapy has been used successfully in the treatment of specific serious infections, ischemic injuries and cerebral arterial gas embolism. The purpose of this study was to evaluate the efficacy and safety of HBO therapy after LTx, generally as indicated for refractory infectious complications. This investigation was a retrospective study of all lung transplant recipients treated with HBO therapy at the Alfred Hospital between March 1990 and August 2005. In this study we describe 9 patients (1.7%) from a total of 544 overall lung transplants performed over the period. Indications included: sternal osteomyelitis (n = 4); refractory cellulitis (n = 2); refractory septic arthritis (n = 1); ischemic toes (n = 1); and cerebral arterial gas embolism (n = 1). The patients received 1 to 25 HBO treatments at 100% Fio(2) and 100 to 180 kPa for 100 minutes per treatment. The treatment was generally well tolerated, although 2 patients ceased therapy prematurely due to a seizure and ear barotrauma (n = 1 each). Five patients had complete resolution of these life-threatening complications. Long-term survival and graft function were excellent, although graft function temporarily fell. HBO is a safe therapy for traditional HBO indications after LTx and appears useful, particularly in the management of infectious complications, whereas other therapies have failed or are contraindicated.