Lung transplantation for ventilator-dependent respiratory failure

Abstract

Introduction: Lung transplantation of patients on mechanical ventilation is controversial, but successful transplantation of these patients has been reported. This report describes our institutional experience with lung transplantation of mechanically ventilated patients since 2003.

Methods: A retrospective cohort study was performed of all adult patients who underwent transplantation between October 2003 and October 2007. The patients on mechanical ventilation before transplantation were compared with patients without mechanical ventilation before transplantation. Survival, intensive care unit and hospital length of stay, post-transplant mechanical ventilation days, and primary graft function were analyzed.

Results: Before transplantation, 15 patients received mechanical ventilation for a median of 20 days (range, 5-90 days); of these, 13 underwent transplantation, and 2 died waiting for transplantation. The control group comprised 70 patients. Time on the transplantation waiting list was significantly shorter for the study group vs the control group. The 2 groups did not differ in survival, post-transplantation hospital time, and primary graft dysfunction scores at 0, 24, 48 and 72 hours after transplantation. Median time of mechanical ventilation after transplantation and median length of stay in the intensive care unit stay were longer in the study group.

Conclusion: The survival rate and post-operative clinical course of patients undergoing transplantation while receiving mechanical ventilation for respiratory failure suggest that these patients can be considered for lung transplantation. Despite a longer time on post-operative mechanical ventilation and length of ICU stay, outcome is similar to that of other lung transplant candidates.