Journal Article

Risk factors for reperfusion injury after lung transplantation

Treggiari, Miriam M., Nicod, Laurent, de Perrot, Marc, Lerch, Nicolas, Spiliopoulos, Anastase, Cottini, Silvia R., Ricou, Bara

2006

Overview

To assess the influence of recipient's and donor's factors as well as surgical events on the occurrence of reperfusion injury after lung transplantation. Retrospective study in the surgical intensive care unit (ICU) of a university hospital. We collected data on 60 lung transplantation donor/recipient pairs from June 1993 to May 2001, and compared the demographic, peri- and postoperative variables of patients who experienced reperfusion injury (35%) and those who did not. The occurrence of high systolic pulmonary pressure immediately after transplantation and/or its persistence during the first 48 h after surgery was associated with reperfusion injury, independently of preoperative values. Reperfusion injury was associated with difficult hemostasis during transplantation (p=0.03). Patients with reperfusion injury were more likely to require the administration of catecholamine during the first 48 h after surgery (p=0.014). The extubation was delayed (p=0.03) and the relative odds of ICU mortality were significantly greater (OR 4.8, 95% CI: 1.06, 21.8) in patients with reperfusion injury. Our analysis confirmed that preexisting pulmonary hypertension increased the incidence of reperfusion injury (p<0.01). Difficulties in perioperative hemostasis were associated with reperfusion injury. Occurrence of reperfusion injury was associated with postoperative systolic pulmonary hypertension, longer mechanical ventilation and higher mortality. Whether early recognition and treatment of pulmonary hypertension during transplantation can prevent the occurrence of reperfusion injury needs to be investigated.

• Publisher: Springer,Springer Nature B.V
• Subject: Adult / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Anesthesiology / Biological and medical sciences / Blood & organ donations / Blood and lymphatic vessels / Bone marrow, stem cells transplantation. Graft versus host reaction / Cardiology. Vascular system / Care and treatment / Cohort Studies / Critical Care / Diagnosis / Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous / Edema / Female / Hospitals / Humans / Intensive care / Intensive care medicine / Lifesaving / Lung Transplantation / Lung transplants / Lungs / Male / Medical sciences / Middle Aged / Mortality / Perioperative Care / Pulmonary hypertension / Reperfusion Injury - epidemiology / Reperfusion Injury - etiology / Reperfusion Injury - physiopathology / Retrospective Studies / Risk Factors / Switzerland - epidemiology / Thoracic surgery / Transfusions. Complications. Transfusion reactions. Cell and gene therapy / Transplantation / Ventilators