[Lung transplantation for emphysema: retrospective study of 65 patients]. / Trasplante pulmonar por enfisema: análisis retrospectivo de 65 pacientes.

BACKGROUND AND OBJECTIVE: Our goal was to analyze the incidence of perioperative complications in patients with pulmonary emphysema who underwent lung transplantation and to identify variables associated with the incidence of morbidity and mortality during the immediate postoperative period. PATIENTS AND METHOD: We undertook a retrospective study of 65 pulmonary emphysema patients who received lung transplants from 1994 through 2002 with the aim of determining the most common intra- and early postoperative complications in the ICU. An univariate analysis was carried out in order to identify variables associated with the incidence of mortality and postoperative complications. Those variables showing statistical significance underwent a multivariate analysis, by means of a pattern of logistic regression, in order to calculate the odds ratio and confidence interval. RESULTS: Seventeen patients received single-lung transplants (SLT) and 48 patients received sequential double-lung transplants (DLT). Intraoperative complications appeared more frequently in the DLT group. Most frequent complications during surgery were reperfusion syndrome (44.6%) and pulmonary hypertension (16.9%). The intraoperative survival was 100%. Fifty-five patients had some type of postoperative complication. Commonest postoperative complications were infection (56.9%) and primary graft failure (36.6%). In the early postoperative period the mortality rate was 16.9%. Main cause of death in the ICU was sepsis (54.5%). A time of mechanical ventilation > 48 hours and postoperative hemorrhage were the variables with a higher predictive value for mortality in the early postoperative period. CONCLUSIONS: Patients with SLT had a lower rate of perioperative complications and a higher survival during their stay in the ICU. Time of mechanical ventilation > 48 hours and postoperative hemorrhage were the variables that best predicted death in the early postoperative period following lung transplantation. Despite our experience, however, perioperative mortality in lung transplantation remains high up to this day.

Trasplante pulmonar por enfisema: análisis retrospectivo de 65 pacientes / Lung transplantation for emphysema: retrospective study of 65 patients

Fundamento y objetivo: Describir la incidencia de complicaciones perioperatorias de los pacientes trasplantados de pulmón por enfisema pulmonar y estudiar los factores de riesgo asociados a la morbimortalidad en el postoperatorio inmediato. Pacientes y método: Estudio retrospectivo que incluye a 69 pacientes trasplantados de pulmón por enfisema pulmonar durante los años 1994-2002. Se realizó un análisis univariante para identificar las variables asociadas con la incidencia de la mortalidad en la Unidad de Reanimación o con el aumento de complicaciones postoperatorias. Las variables que presentaron significación estadística se sometieron a análisis multivariante mediante el modelo de regresión logística. Resultados: Se incluyó a 65 pacientes. Diecisiete recibieron un trasplante unipulmonar (TUP) y 48 un transplante bilateral secuencial (TBP). Las complicaciones intraoperatorias fueron más habituales en el grupo del trasplante bipulmonar (35,3% en el TBP frente a 72,9% en el TUP, p < 0,006), y las complicaciones intraoperatorias más frecuentes fueron el síndrome posreperfusión y la hipertensión pulmonar . No hubo ningún caso de mortalidad intraoperatoria en la serie. Las complicaciones postoperatorias más frecuentes fueron la infección (56,9%) y el fallo primario del injerto (36,6%). Cincuenta y cinco pacientes presentaron alguna complicación en el postoperatorio inmediato. La mortalidad global en el postoperatorio fue del 16,9%, y que la sepsis (54,5%) la causa más frecuente de fallecimiento en el postoperatorio inmediato. La ventilación mecánica durante más de 48 h y la hemorragia posquirúrgica fueron las variables con mayor valor predictivo de mortalidad en el postoperatorio Conclusiones: Los pacientes con TUP tienen menor número de complicaciones en el perioperatorio, lo que condiciona una mayor supervivencia durante la estancia en reanimación. La ventilación mecánica durante más de 48 h y la hemorragia posquirúrgica fueron las variables que mejor predijeron la mortalidad en el postoperatorio inmediato

Background and objective: Our goal was to analyze the incidence of perioperative complications in patients with pulmonary emphysema who underwent lung transplantation and to identify variables associated with the incidence of morbidity and mortality during the immediate postoperative period. Patients and method: We undertook a retrospective study of 65 pulmonary emphysema patients who received lung transplants from 1994 through 2002 with the aim of determining the most common intra- and early postoperative complications in the ICU. An univariate analysis was carried out in order to identify variables associated with the incidence of mortality and postoperative complications. Those variables showing statistical significance underwent a multivariate analysis, by means of a pattern of logistic regression, in order to calculate the odds ratio and confidence interval. Results: Seventeen patients received single-lung transplants (SLT) and 48 patients received sequential double-lung transplants (DLT). Intraoperative complications appeared more frecuently in the DLT group. Most frequent complications during surgery were reperfusion syndrome (44.6%) and pulmonary hypertension (16.9%). The intraoperative survival was 100%. Fifty-five patients had some type of postoperative complication. Commonest postoperative complications were infection (56.9%) and primary graft failuree (36.6%). In the early postoperative period the mortality rate was 16.9 %. Main cause of death in the ICU was sepsis (54.5%). A time of mechanical ventilation > 48 hours and postoperative hemorrhage were the variables with a higher predictive value for mortality in the early postoperative period. Conclusions: Patients with SLT had a lower rate of perioperative complications and a higher survival during their stay in the ICU. Time of mechanical ventilation > 48 hours and postoperative hemorrhage were the variables that best predicted death in the early postoperative period following lung transplantation. Despite our experience, however, perioperative mortality in lung transplantation remains high up to this day