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Observational Study
. 2021 Apr 7;16(4):e0249758.
doi: 10.1371/journal.pone.0249758. eCollection 2021.

The influence of the native lung on early outcomes and survival after single lung transplantation

Francisco Javier Gonzalez  1 , Enriqueta Alvarez  1 , Paula Moreno  1 , David Poveda  1 , Eloisa Ruiz  1 , Alba Maria Fernandez  1 , Angel Salvatierra  1 , Antonio Alvarez  1
Affiliations
Observational Study

The influence of the native lung on early outcomes and survival after single lung transplantation

Francisco Javier Gonzalez et al. PLoS One. .

Abstract

Objective: To determine whether problems arising in the native lung may influence the short-term outcomes and survival after single lung transplantation (SLT), and therefore should be taken into consideration when selecting the transplant procedure.

Patients and methods: Retrospective review of 258 lung transplants performed between June 2012 and June 2019. Among them, 161 SLT were selected for the analysis. Complications in the native lung were recorded and distributed into two groups: early and late complications (within 30 days or after 30 days post-transplant). Donor and recipient preoperative factors, 30-day mortality and survival were analysed and compared between groups by univariable and multivariable analyses, and adjusting for transplant indication.

Results: There were 161 patients (126M/35F; 57±7 years) transplanted for emphysema (COPD) (n = 72), pulmonary fibrosis (IPF) (n = 77), or other indications (n = 12). Forty-nine patients (30%) presented complications in the native lung. Thirty-day mortality did not differ between patients with or without early complications (6% vs. 12% respectively; p = 0.56). Twelve patients died due to a native lung complication (7.4% of patients; 24% of all deaths). Survival (1,3,5 years) without vs. with late complications: COPD (89%, 86%, 80% vs. 86%, 71%, 51%; p = 0.04); IPF (83%, 77%, 72% vs. 93%, 68%, 58%; p = 0.65). Among 30-day survivors: COPD (94%, 91%, 84% vs. 86%, 71%, 51%; p = 0.01); IPF (93%, 86%, 81% vs. 93%, 68%, 58%; p = 0.19). Native lung complications were associated to longer ICU stay (10±17 vs. 33±96 days; p<0.001), longer postoperative intubation (41±85 vs. 99±318 hours; p = 0.006), and longer hospital stay (30±24 vs. 45±34 days; p = 0.03). The presence of late native lung problems predicted survival in COPD patients (OR: 2.55; p = 0.07).

Conclusion: The native lung is a source of morbidity in the short-term and mortality in the long-term after lung transplantation. This should be taken into consideration when choosing the transplant procedure, especially in COPD patients.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. 30-day mortality.
A) 30-day mortality of COPD vs. IPF patients after single lung transplantation. B) 30-day mortality in patients with or without native lung complications (overall study group). C) 30-day mortality in COPD patients with or without native lung complications. D) 30-day mortality in IPF patients with or without native lung complications.
Fig 2
Fig 2. Survival in IPF patients.
Post-transplant survival of IPF patients comparing those with or without native lung complications (left), and those with early or late native lung complications (right).
Fig 3
Fig 3. Survival in COPD patients.
Post-transplant survival of COPD patients comparing those with or without native lung complications (left), and those with early or late native lung complications (right).
Fig 4
Fig 4. Survival in COPD patients conditional to survive 30 days.
Post-transplant survival, conditional to survive 30 days, of COPD patients comparing those with or without native lung complications (left), and those with early or late native lung complications (right).
Fig 5
Fig 5. Survival in IPF patients conditional to survive 30 days.
Post-transplant survival, conditional to survive 30 days, of IPF patients comparing those with or without native lung complications (left), and those with early or late native lung complications (right).
See this image and copyright information in PMC

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