Lung retransplant. Experience of a referral centre. / Retrasplante pulmonar. Experiencia de un centro de referencia.

BACKGROUND: Lung retransplantation (LR) is a valid choice with a significant risk of perioperative morbidity and mortality in selected patients with graft dysfunction after lung transplantation. Our goal is to analyse our experience in LR in terms of survival and lung function. METHODS: Retrospective study of patients undergoing LR (1990-2019). VARIABLES: recipients and procedure, early mortality, survival and lung function in patients with CLAD. Quantitative variables (mean±SD); qualitative (%). Student's t test or χ2 was used. Survival was estimated using Kaplan-Meier, compared with Log Rank. A p < 0.05 was established as significant. RESULTS: Of 784 transplanted patients, 25 patients (mean age 38.41-16.3 years, 12 men and 13 women) were LR; (CLAD (n = 19), pulmonary infarction (n = 2), airway complications (n = 2), graft dysfunction (n = 1), hyperacute rejection (n = 1), mean time to retransplantation: 5.41 ± 3.87 years in CLAD and 21.2 ± 21.4 days in non-CLAD. The 90-day mortality was 52% and 36.8% in the second period (p = 0.007), being higher in patients who required preoperative ECMO (80 vs. 20%, p = 0.04). The 1- and 5-year survival was 53.9% and 37.7%, respectively (p = 0.016). Survival of the CLAD group was greater (p = 0.08). Pre LR ECMO decreased survival (p = 0.032). After LR, FEV1 improved an average of 0.98 ± 0.13L (25.6 ± 18.8%) (p = 0.001). CONCLUSIONS: LR is a high mortality procedure that requires careful selection of patients with better results in patients with CLAD. The lung function of patients with CLAD improved significantly.

Mortalidad perioperatoria / Perioperative mortality

Introducción: La tasa de mortalidad perioperatoria representa un indicador global del acceso seguro a la atención quirúrgica y anestesiológica. Objetivo: Caracterizar los pacientes fallecidos durante el perioperatorio en intervenciones quirúrgicas. Métodos: Se realizó un estudio descriptivo transversal en el servicio de Anestesiología del Hospital Clínico Quirúrgico Arnaldo Milián Castro, provincia Villa Clara, en el periodo período de enero de 2015 a diciembre de 2018. La población estuvo constituida por los pacientes intervenidos quirúrgicamente en dicho hospital (N: 133 724). La muestra fueron los pacientes fallecidos durante el período intraoperatorio y primeras 24 h tras la intervención quirúrgica (n: 77). Resultados: La tasa de mortalidad perioperatoria general fue de 5,76/10 000. Incidencia de mortalidad mayor en hombres (59,7 por ciento), ancianos (75,3 por ciento), con varias comorbilidades asociadas (51,9 por ciento), clase 4 de la ASA (41,5 por ciento), riesgo quirúrgico grupo II (62,3 por ciento), cirugía abdominal (63,6 por ciento), intervenciones de urgencia (88,3 por ciento), bajo una técnica anestésica general (84,4 por ciento) y en el período postoperatorio 24 h (68,8 por ciento). El shock séptico constituyó la principal causa de mortalidad (48,1 por ciento). Conclusiones: Predominaron las defunciones en ancianos con comorbilidades asociadas, alto riesgo anestésico y quirúrgico, intervenidos de urgencia bajo anestesia general, con el shock séptico como principal causa de muerte. La tasa de mortalidad perioperatoria fue similar a naciones de desarrollo socioeconómico equivalente(AU)

Introduction: Perioperative mortality rate represents a global indicator for safe access to surgical and anesthesiological care. Objective: To characterize patients who deceased during the perioperative period in surgical interventions. Methods: A cross-sectional and descriptive study was carried out in the anesthesiology service of Arnaldo Milián Castro Clinical-Surgical Hospital, in Villa Clara Province, in the period from January 2015 to December 2018. The study population consisted of patients who received surgery within that hospital (N: 133 724). The sample consisted of patients who died during the intraoperative period and within the first 24 hours after surgery (n: 77). Results: The general perioperative mortality rate was 5.76/10 000. There was incidence of higher mortality among men (59.7 percent), elderlies (75.3 percent), patients with several associated comorbidities (51.9 percent), those classified as ASA-IV (41.5 percent), those belonging to group II for surgical risk (62.3 percent), cases of abdominal surgery (63.6 percent), emergency interventions (88.3 percent), patients under general anesthetic technique (84.4 percent), and at 24 hours after the postoperative period (68.8 percent). Septic shock was the main cause of mortality (48.1 percent). Conclusions: There was a predominance of deaths among elderlies with associated comorbidities, high anesthetic, as well as surgical risk, who received emergency surgery under general anesthesia, being septic shock the main cause of death. The perioperative mortality rate was similar to that in nations of equivalent socioeconomic development(AU)

[Perioperative mortality of lung transplantation in chronic obstructive pulmonary disease]. / Mortalidad perioperatoria del trasplante pulmonar en la enfermedad pulmonar obstructiva crónica.

INTRODUCTION: Lung transplantation (LT) has been considered an alternative therapeutic approach in terminal patients. However, this process in COPD is not controversy-free. This paper aimed to analyze 30-day mortality (PM) patterns and their risk factors in COPD patients undergoing LT. PATIENTS AND METHOD: A retrospective cohort with 107 COPD patients, transplanted at the University La Fe Valencia, Spain, treated from January 1991 to December 2008. Demographics values, degree of dyspnoea, diagnosis, BODE index, single versus bilateral LT, cardio-pulmonary bypass, donor age, steroid dependence, presence of bronchiectasis, retrograde perfusion, transfusion of blood products, and PaO2/FiO2 were analyzed. Continuous variables were expressed as mean±SD and categorical variables as absolute frequency and percentage. A Cox regression model was used for multivariate analysis. RESULTS: Ninety-four men and 13 women of a mean age of 52.58±8.05 years were transplanted. Of all patients, 75% obtained a BODE score above 7. There were 76 bilateral LT. PM was established at 14%. Main causes of death were infection (53.3%) and surgical complications (33.3%). Presence of bronchiectasis and chronic use of corticosteroids, donor/recipient difference in size and presence of fat in retrograde perfusion fluid were important risk factors for PM. Moreover, PaO2/FiO2 ratio at 6h was a protective factor for the event, thus a higher ratio value, lowered the risk of PM. CONCLUSIONS: LT is a procedure with a high PM rate. Use of corticosteroids, the presence of bronchiectasis and fat emboli in the retrograde reperfusion, and PaO2/FiO2 significantly determine PM.