25. REPERFUSION INJURY SIGNIFICANTLY IMPACTS CLINICAL OUTCOME FOLLOWING PULMONARY TRANSPLANTATION
Robert C. King, Oliver A.R. Binns, Filiberto Rodriguez, R. Chai Kanithanon, Thomas M. Daniel*, William D. Spotnitz*, Curtis G. Tribble*, and Irving L. Kron*
University of Virginia, Department of Thoracic and Cardiovascular Surgery
Charlottesville, Virginia, USA
BACKGROUND
We hypothesized that reperfusion injury would contribute significantly to post operative pulmonary dysfunction resulting in prolonged critical care management and increased in-hospital mortality following lung transplantation. Additionally, we hypothesized that the incidence and severity of reperfusion injury would be dependent upon the etiology of recipient lung disease as well as the interval of donor allograft ischemia.
MATERIAL AND METHODS
We performed a retrospective study of patients undergoing lung transplantation at our institution from June 1990 until June 1998 in order to determine the overall clinical incidence and impact of reperfusion injury. Ninety-nine patients received 120 organs during this time period. We analyzed data regarding donor and recipient pathophysiology, perioperative pulmonary function and hemodynamics, as well as clinical course and outcome. We compared two groups of patients in this study; those who had significant reperfusion injury (RI) and those who did not (NRI). Twenty-two percent (22/99) of all lung transplant recipients had a clinically significant reperfusion injury. The severity of reperfusion injury was determined by the severity of diffuse pulmonary infiltrate on chest x-ray and degree of ventilatory support during the first 48 hours after transplantation.
|
Group |
Organ Ischemia (min) |
Length of Ventilation (hours) |
Length of Stay (days) |
ICU Length of Stay (days) |
Total Costs ($ US) |
Mortality (In Hospital) |
|
RI(n=22) |
221.5 ± 11.8 |
393.5 ± 81.6* |
48.8 ± 9.9* |
22.2 ± 4.2* |
145,646 ± 16,700* |
40.9%(9/22) |
|
NRI(n=77) |
252.9 ± 21.9 |
56.8 ± 12.4 |
25.6 ± 2.0 |
10.5 ± 2.1 |
95,630 ± 6,112 |
11.7%(9/77) |
|
|
P =NS |
P <0.001 |
P <0.03 |
P <0.01 |
P <0.01 |
P <0.002 |
The incidence of reperfusion injury was significantly greater in patients undergoing transplantation for preexisting pulmonary hypertension (6/14) than those with COPD or emphysema alone (6/54) (42.9% vs 11.1%, P<0.012). Moderate to severe reperfusion injury significantly increased hospital mortality, the length of postoperative ventilation, ICU stay, overall length of stay, and total hospital costs. The incidence of reperfusion injury was not effected by duration of donor ischemia but was related to the presence of preoperative pulmonary hypertension.
CONCLUSION
These findings suggest that recipient pathophysiology as well as quality of donor allograft may play important roles in determining the incidence of significant reperfusion injury.
