Perioperative mortality of lung transplantation in chronic obstructive pulmonary disease

Abstract 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 analyse 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 PaO 2 /FiO 2 were analysed. 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, PaO 2 /FiO 2 ratio at 6 h 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 PaO 2 /FiO 2 significantly determine PM.