The Impact of Pretransplant Mechanical Ventilation on Short- and Long-Term Survival After Lung Transplantation

Abstract

Lung transplantation in mechanically ventilated (MV) patients has been associated with decreased post-transplant survival. Under the Lung Allocation Score (LAS) system, patients at greatest risk of death on the waiting list, particularly those requiring MV, are prioritized for lung allocation. We evaluated whether pre-transplant MV is associated with poorer post-transplant survival in the LAS era. Using a national registry, we analyzed all adults undergoing lung transplantation in the U.S. from 2005-2010. Propensity scoring identified non-ventilated matched referents for 419 subjects requiring MV at the time of transplantation. Survival was evaluated using Kaplan-Meier methods. Risk of death was estimated by hazard ratios employing time-dependent covariates. We found that pre-transplant MV was associated with decreased overall survival after lung transplantation. In the first six-months post-transplant, ventilated subjects had a two-fold higher risk of death compared to non-ventilated subjects. However, after six-months post-transplant, survival did not differ by MV status. We also found that pre-transplant MV was not associated with decreased survival in non-cystic fibrosis obstructive lung diseases. These results suggest that under the LAS, pre-transplant MV is associated with poorer short-term survival post-transplant. Notably, the increased risk of death appears to be strongest the early post-transplant period and limited to certain pre-transplant diagnoses.

Body Composition and Mortality after Adult Lung Transplantation in the United States

“…This modest sample size tempers our ability to make robust conclusions or estimate obesity-related risk for other diagnoses. Compared with other BMI strata, these patients tended to have fibrotic lung disease, be hospitalized, and receive invasive mechanical ventilation, all known risk factors for early mortality (see Table E1) (1,52). After adjustment for these factors, however, the risk of early mortality was only slightly attenuated.…”

Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation

“…1 For some patients awaiting lung transplantation, disease progression leads to deterioration and respiratory failure necessitating life support, which is associated with worse post-transplant outcomes. [2][3][4] For individuals who require mechanical ventilation before lung transplantation, the 1-y survival rate is 57-62% in comparison with 75-80% for those who are not supported with invasive ventilation at the time of transplant. [2][3][4] Initial studies of subjects who required extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation demonstrated even lower survival rates.…”

“…[2][3][4] For individuals who require mechanical ventilation before lung transplantation, the 1-y survival rate is 57-62% in comparison with 75-80% for those who are not supported with invasive ventilation at the time of transplant. [2][3][4] Initial studies of subjects who required extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation demonstrated even lower survival rates. [4][5][6] These survival trends are likely representative of historically late initiation of ECMO for those patients in need of lung transplantation.…”

Resultados del trasplante pulmonar en pacientes en situación de urgencia

“…el registro de la iSHlT y varios estudios muestran que la vMi y el eCMo pre-trasplante son factores de riesgo de muerte en el post-trasplante inmediato 6,7 . el uso de vMni y eCMo despierto (Awake eCMo) pre-trasplante permitió en nuestra serie la rehabilitación muscular y la mejoría nutricional en un grupo de pacientes previo al trasplante.…”