Hospital length of stay after lung transplantation: Independent predictors and association with early and late survival

Banga, Amit; Mohanka, Manish; Mullins, Jessica; Bollineni, Srinivas; Kaza, Vaidehi; Ring, W. Steves; Bajona, Pietro; Peltz, Matthias; Wait, Michael A.; Torres, Fernando

doi:10.1016/j.healun.2016.07.020

Cited by 42 publications

(34 citation statements)

References 27 publications

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“…The increasing incidence of lung transplantation has raised interest in identifying prognostic indicators for survival including recipient characteristics and donor characteristics . There has been limited data to predict longer survival, with initial studies identifying bilateral transplants and decreased hospitalization as positive predictors .…”

Section: Introductionmentioning

confidence: 99%

Long term survival after lung transplantation: A single center experience

et al. 2019

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Background: There are approximately 2000 lung transplants performed across the United States annually. There is limited data to identify factors predictive of longterm survival. Objective: We evaluated 10-year survivors after lung transplant to determine predictors of long-term survival. Methods: Data were collected from the United Network for Organ Sharing registry database from a single institution. Inclusion criteria were: patients who received a lung transplant between 1989 and 2005. Descriptive statistics were calculated, and survival outcomes were analyzed using the Kaplan-Meier method.

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Section: Introductionmentioning

confidence: 99%

Long term survival after lung transplantation: A single center experience

et al. 2019

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“…Disabled or worse functional status, admission to the hospital or intensive care unit at the time of transplant, and need of ECMO support were associated with 1‐year survival in previous studies . Although the use of the ventilator as a bridge to transplant was associated with 30‐day mortality on univariate analysis, it did not emerge as an independent predictor perhaps due to adjustment for functional status in the multivariable model.…”

Section: Discussionmentioning

confidence: 80%

“…Only a few donor variables were predictive of 30‐day mortality. None of the previously identified variables with adverse prognostic significance such as donor age, history of smoking, or gender mismatch had an association with 30‐day mortality. Neither were any of the variables reflecting the physiologic function of the lungs such as the PaO 2 to FiO 2 ratio.…”

Section: Discussionmentioning

confidence: 87%

“…However, this association is independent of several other pertinent variables linked to the complexity of transplant surgery including the underlying diagnosis, previous chest surgery, elevated pulmonary pressures, and type of transplant (single vs bilateral). Association of ischemic time with outcomes after lung transplantation has been extensively studied in the past, and there have been conflicting . Whereas older studies found an association of longer ischemic times with allograft dysfunction and increased hazard of post‐transplant mortality, more recent data did not support this association .…”

Section: Discussionmentioning

confidence: 99%

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Incidence and variables associated with 30‐day mortality after lung transplantation

Banga

Mohanka

Mullins

et al. 2019

Clinical Transplantation

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Background:With the introduction of the lung allocation score (LAS), sicker patients are prioritized for lung transplantation (LT). There is a lack of data regarding variables independently associated with 30-day mortality after LT. Methods:We queried the UNOS database for adult patients undergoing LT between 1989 and 2014. Patients with dual organ or previous transplantation and those with missing survival data were excluded. Mortality during the first 30 days after LT was the primary outcome variable. Results:The yearly trends indicate a statistically significant reduction in the 30-day mortality during the study period (P < 0.001, overall mortality: 5.5%) which has continued in the post-LAS era (P = 0. 014, overall mortality: 3.6%). Among patients with 30-day mortality, "primary non-function" (n = 118, 72.8%) was reported as the most common etiology. Transplant indication of vascular diseases, history of non-transplant cardiac or lung surgery, mean pulmonary pressures >35 mm Hg, disabled functional status, ECMO support, high LAS, ischemic time >6 hours, and blunt injury as the mechanism of donor death are independently associated with 30-day mortality. Conclusion:The incidence of early mortality after LT continues to decline in the post-LAS era. Apart from the mechanism of donor death and ischemic time, early mortality appears to be primarily driven by the recipient characteristics. K E Y W O R D S30-day survival, ECMO, ischemic time, need of dialysis, postoperative mortality

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“…There are no studies on sepsis and morbidity in pediatric LTRs. The increased morbidity with prolonged hospital stay in the septic CF LTRs in this study is particularly important because, as Banga et al showed, prolonged hospital LOS negatively impacted 1‐ and 3‐year survival as it represents important donor and recipient variables from the peri‐operative to the post‐operative period …”

Section: Discussionmentioning

confidence: 99%

Risk factors for infection after pediatric lung transplantation

Onyearugbulem

Williams

Zhu

et al. 2018

Transplant Infectious Dis

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Although infection is the leading cause of death in the first year following pediatric lung transplantation, there are limited data on risk factors for early infection. Sepsis remains under-recognized and under-reported in the early post-operative period for lung transplant recipients (LTR). We evaluated the incidence of infection and sepsis, and identified risk factors for infection in the early post-operative period in pediatric LTRs. A retrospective review of medical records of LTRs at a large quaternary-care hospital from January 2009 to March 2016 was conducted. Microbiology results on days 0-7 after transplant were obtained. Sepsis was defined using the 2005 International Pediatric Consensus Conferencecriteria. Risk factors included history of recipient and donor infection, history of multi-drug resistant (MDR) infection, nutritional status, and surgical times. Among the 98 LTRs, there were 22 (22%) with post-operative infection. Prolonged donor ischemic time ≥7 hours, cardiopulmonary bypass(CPB) time ≥340 minutes, history of MDR infection and diagnosis of cystic fibrosis were significantly associated with infection. With multivariable regression analysis, only prolonged donor ischemic time remained significant (OR 4.4, 95% CI: 1.34-14.48). Further research is needed to determine whether processes to reduce donor ischemic time could result in decreased post-transplant morbidity.

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Hospital length of stay after lung transplantation: Independent predictors and association with early and late survival

Cited by 42 publications

References 27 publications

Long term survival after lung transplantation: A single center experience

Long term survival after lung transplantation: A single center experience

Incidence and variables associated with 30‐day mortality after lung transplantation

Risk factors for infection after pediatric lung transplantation

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