Outcome predictors in lung transplant patients

ABSTRACT

Lung transplantation has become an established treatment for selected patients with end stage pulmonary disease. The Alveolar-arterial [A-a] gradient shown to be useful marker of post-operative pulmonary morbidity in patients undergoing single lung transplantation. The purpose of this study was to determine the utility of the [A-a] gradient in predicting post-operative morbidity and mortality in patients undergoing single as well as double lung transplantation. A retrospective study was done in a single institution where 25 patient underwent lung transplantation, [A-a] gradients were calculated for each patient pre-operative, post-operative and a variable post-operative minus pre-operative, linear regression was performed to assess the relationship between each A-a gradient variable and overall morbidity [including infection, neurological, respiratory and renal complications] as well as mortality. Using the [A-a] gradient measurement peri-operatively we found that there was a significant relation to overall morbidity. Patients with a 50 point higher [A-a] gradient change post-operatively from pre-operative value would be 1.8 times more likely to have morbidity. This study shows that using the pre-operative and post-operative [A-a] gradient can be useful and easy tool to predict post-operative morbidity