Lara C. Pullen, PhD

November 01, 2013

CHICAGO — Patients who have undergone lung transplantation have significant short-term mortality after discharge from intensive care. Those who are partly or fully dependent on caregivers are unlikely to survive 6 months, a new study shows.

"Functional status has a strong association with short-term outcomes for lung transplant patients," explained Amit Banga, MD, from the Cleveland Clinic.

Dr. Banga presented the research here at CHEST 2013: American College of Chest Physicians Annual Meeting, where he was a semifinalist for the Young Investigator Award.

An increasing number of patients undergo lung transplantation every year, but the profile and outcomes of the patients who require intensive care have yet to be extensively evaluated.

Dr. Banga's team conducted a register chart review of patients admitted to the 69-bed intensive care unit at the Cleveland Clinic. They reviewed charts and discharge summaries to determine the cause of decompensation that precipitated intensive care admission.

They also looked at functional status at discharge. Patients requiring no assistance were classified as independent, and those requiring a caregiver were classified as either partially or fully dependent.

During the study period, 101 of the 4000 patients admitted to intensive care had undergone lung transplantation. For 54% of those, the indication for transplantation was chronic obstructive pulmonary disease.

Approximately half of the lung transplant patients experienced acute respiratory failure. "Infection seems to be the dominant culprit," explained Dr. Banga. In addition, approximately half of the patients required invasive ventilation.

Table. Cause of Acute Respiratory Failure in Lung Transplant Patients

Cause Percent (n = 51)
Infection 46
Fluid overload 20
Antibody-mediated rejection 12
Other 22


Dr. Banga reported that 87.1% of lung transplant patients survived to hospital discharge. Functional status at discharge was the only independent predictor of survival at 6 months.

Dr. Banga pointed out that the study was limited by its sample size and the fact that some of the data were obtained by chart review. In addition, associations could have been hidden by confounders.

He emphasized, however, that "this is the largest study to date."

"Functionality is really just a surrogate that the patient isn't doing as well," comoderator Jeffrey Cary, MD, from Minor & James Medical in Seattle, told Medscape Medical News.

"I think having a control group for comparison is very important," added comoderator Kevin Chan, MD, from the University of Michigan in Ann Arbor. He pointed out that the study didn't really address whether lung transplantation makes it worse for patients. He mentioned the possibility that the outcomes reported in the study are typical for patients who enter intensive care with acute respiratory failure, and may not be specific to lung transplant patients.

Dr. Banga, Dr. Cary, and Dr. Chan have disclosed no relevant financial relationships.

CHEST 2013: American College of Chest Physicians Annual Meeting. Presented October 28, 2013.


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