ABSTRACT
This study was conducted to evaluate whether a pulmonary rehabilitation program (PRP) is independently associated with survival in patients with idiopathic pulmonary fibrosis (IPF) undergoing lung transplant (LTx). This quasi-experimental study included 89 patients who underwent LTx due to IPF. Thirty-two completed all 36 sessions in a PRP while on the waiting list for LTx (PRP group), and 53 completed fewer than 36 sessions (controls). Survival after LTx was the main outcome; invasive mechanical ventilation (IMV), length of stay (LOS) in intensive care unit (ICU) and in hospital were secondary outcomes. Kaplan-Meier curves and Cox regression models were used in survival analyses. Cox regression models showed that the PRP group had a reduced 54.0% (hazard ratio = 0.464, 95% confidence interval 0.222-0.970, p = 0.041) risk of death. A lower number of patients in the PRP group required IMV for more than 24 hours after LTx (9.0% vs. 41.6% p = 0.001). This group also spent a mean of 5 days less in the ICU (p = 0.004) and 5 days less in hospital (p = 0.046). In conclusion, PRP PRP completion halved the risk of cumulative mortality in patients with IPF undergoing unilateral LTx.
Subject(s)
Idiopathic Pulmonary Fibrosis/rehabilitation , Idiopathic Pulmonary Fibrosis/surgery , Lung Transplantation , Adult , Aged , Female , Humans , Idiopathic Pulmonary Fibrosis/mortality , Kaplan-Meier Estimate , Lung Transplantation/methods , Male , Middle Aged , Perioperative Care , Prognosis , Recovery of Function , Rehabilitation/methods , Respiration, Artificial , Respiratory Function Tests , Retrospective Studies , Treatment OutcomeSubject(s)
Adult , Female , Humans , Cardiopulmonary Bypass , Kartagener Syndrome/surgery , Lung Transplantation/methodsSubject(s)
Cardiopulmonary Bypass , Kartagener Syndrome/surgery , Lung Transplantation/methods , Adult , Female , HumansABSTRACT
OBJECTIVE: To evaluate post-operative complications in living lobar lung transplant donors. METHODS: Between September of 1999 and May of 2005, lobectomies were performed in 32 healthy lung transplant donors for 16 recipients. The medical charts of these donors were retrospectively analyzed in order to determine the incidence of postoperative complications and alterations in pulmonary function after lobectomy. RESULTS: Twenty-two donors (68.75%) presented no complications. Among the 10 donors presenting complications, the most frequently observed complication was pleural effusion, which occurred in 5 donors (15.6% of the sample). Red blood cell transfusion was necessary in 3 donors (9.3%), and 2 donors underwent a second surgical procedure due to hemothorax. One donor presented pneumothorax after chest tube removal, and one developed respiratory infection. There were two intra-operative complications (6.25%): one donor required bronchoplasty of the middle lobe; and another required lingular resection. No intra-operative mortality was observed. Post-operative pulmonary function tests demonstrated an average reduction of 20% in forced expiratory volume in one second (p < 000.1) compared to pre-operative values. CONCLUSIONS: Lobectomy in living lung transplant donors presents high risk of post-operative complications and irreversible impairment of pulmonary function. Careful pre-operative evaluation is necessary in order to reduce the incidence of complications in living lobar lung transplant donors.
Subject(s)
Living Donors , Lung Transplantation , Pneumonectomy/methods , Postoperative Complications , Adolescent , Adult , Child , Female , Forced Expiratory Volume , Humans , Lung Transplantation/adverse effects , Lung Transplantation/mortality , Male , Middle Aged , Pneumonectomy/adverse effects , Postoperative Complications/mortality , Postoperative Period , Preoperative Care , Retrospective Studies , SpirometryABSTRACT
OBJETIVO: Avaliar as complicações pós-operatórias imediatas de doadores vivos de lobos pulmonares para transplante. MÉTODOS: Entre setembro de 1999 e maio de 2005 foram realizadas lobectomias em 32 doadores saudáveis para transplante pulmonar em 16 receptores. Os prontuários médicos destes doadores foram analisados retrospectivamente para verificar a incidência de complicações pós-operatórias e as alterações da função pulmonar após a lobectomia. RESULTADOS: Vinte e dois doadores (68,75 por cento) não apresentaram complicações. Entre os 10 casos que apresentaram alguma complicação o derrame pleural foi a mais freqüente, ocorrendo em 5 deles (15,6 por cento da amostra). Três doadores (9,3 por cento) necessitaram de transfusão de hemácias e, em 2 casos, foi necessária nova intervenção cirúrgica devido a hemotórax. Um doador apresentou pneumotórax após a retirada do dreno de tórax e houve um caso de infecção respiratória. Ocorreram duas intercorrências intra-operatórias (6,25 por cento): em um doador foi realizada broncoplastia do lobo médio; em outro, foi necessária a ressecção da língula. Não houve mortalidade cirúrgica nesta série. As provas de função pulmonar do pós-operatório demonstraram uma redução média de 20 por cento no volume expiratório forçado no primeiro segundo (p < 000,1), em comparação com os valores verificados antes da cirurgia. CONCLUSÕES: A lobectomia em doadores pulmonares vivos para transplante apresenta elevado risco de complicações pós-operatórias e resulta em perda definitiva da função pulmonar Uma cuidadosa avaliação pré-operatória faz-se necessária para reduzir a incidência de complicações nos doadores vivos de lobos pulmonares para transplante.
OBJECTIVE: To evaluate post-operative complications in living lobar lung transplant donors. METHODS: Between September of 1999 and May of 2005, lobectomies were performed in 32 healthy lung transplant donors for 16 recipients. The medical charts of these donors were retrospectively analyzed in order to determine the incidence of postoperative complications and alterations in pulmonary function after lobectomy. RESULTS: Twenty-two donors (68.75 percent) presented no complications. Among the 10 donors presenting complications, the most frequently observed complication was pleural effusion, which occurred in 5 donors (15.6 percent of the sample). Red blood cell transfusion was necessary in 3 donors (9.3 percent), and 2 donors underwent a second surgical procedure due to hemothorax. One donor presented pneumothorax after chest tube removal, and one developed respiratory infection. There were two intra-operative complications (6.25 percent): one donor required bronchoplasty of the middle lobe; and another required lingular resection. No intra-operative mortality was observed. Post-operative pulmonary function tests demonstrated an average reduction of 20 percent in forced expiratory volume in one second (p < 000.1) compared to pre-operative values. CONCLUSIONS: Lobectomy in living lung transplant donors presents high risk of post-operative complications and irreversible impairment of pulmonary function. Careful pre-operative evaluation is necessary in order to reduce the incidence of complications in living lobar lung transplant donors.
