Prolonged mechanical ventilation after lung transplantation: risks factors and consequences on recipient outcome

Abstract

Background: Risk factors and the incidence of prolonged mechanical ventilation (PMV) after lung transplantation (LT) have been poorly described. The study assessed predictive factors of PMV after LT.

Methods: This observational, retrospective, monocentric study included all patients who received LT in Bichat Claude Bernard Hospital between January 2016 and December 2020. PMV was defined as a duration of MV > 14 days. Independent risk factors for PMV were studied using multivariate analysis. One-year survival depending on PMV was studied using Kaplan Meier and log-rank tests. A p value <0.05 was defined as significant.

Results: 224 LT recipients were analysed. 64 (28%) of them received PMV for a median duration of 34 [26-52] days versus 2 [1-3] days without PMV. Independent risk factors for PMV were higher body mass index (BMI) (p = 0.031), diabetes mellitus of the recipient (p = 0.039), ECMO support during surgery (p = 0.029) and intraoperative transfusion >5 red blood cell units (p < 0.001). Increased mortality rates were observed at one-year in recipients who received PMV (44% versus 15%, p < 0.001).

Conclusion: PMV was associated with increased morbidity and mortality one-year after LT. Preoperative risk factors (BMI and diabetes mellitus) must be considered when selecting and conditioning the recipients.

Keywords: intensive care unit; lung transplantation; one-year mortality; outcome; prolonged mechanical ventilation.

Figure 1

Flow chart of the study.

Figure 2

Evolution of the percentage of ventilated LT recipients after surgical procedure.

Figure 3

(A,B) 90 days and one-year survival of LT recipients depending on PMV. (C) One-year survival of PMV LT recipients depending on MV duration. (D) One-year survival of PMV LT recipients depending on MV duration after exclusion of patients who died before day 47.