Prolonged Mechanical Ventilation in Lung Transplant Recipients: Predictive Factors and Outcomes

Purpose Prolonged mechanical ventilation (PMV) and consequently longer ICU stays after lung transplantation (LTx), are serious complications but prognosis at medium and long term are not yet know. Our objectives were to identify patients requiring > 21 days of MV after the operation and the predictive factors of PMV, and to evaluate the impact of VMP on survival and functional outcomes at one post-transplant. Methods and Materials Observational retrospective analysis of data relating to 82 consecutive lung transplantation performed at the University Hospital of Marseille from January 2008 to May 2011, for which recipient’ survival was over 21 days. Donors’ and patients’ preoperative, intra operative and postoperative data were recorded. Results 34 recipients met our criteria of PMV and 48 patients did not met them (control group). None factor related to the characteristics of the donor and the recipient at the presurgical evaluation was predictive of PMV. Multivariable regression analysis retained the risk of lung volume reduction (OR 11.874, 95% CI: 1,16-121, 44, p = 0.04), and use of postoperative ECMO within 48 hours (OR 6695, 95% CI: 1,46-30, 75, p = 0.015). By freeing from context, only lung volume reduction stayed a predictive factor of PMV. A significant decrease in survival at 1, 2 and 3 years was observed in PMV patients compared to controls (73.5%, 61.2%, 51% vs. 85.4%, 82.5%, 77.9 %). Compared to controls, in patients who required PMV, lung function at 1 year was significantly impaired with a lowest value of FEV 1 (1681 ± 919 ml vs . 2625 ± 1132 ml, p = 0.001), FVC (2288 ± 1076 ml vs 3450 ± 1176 ml, p = 0.001), LTC (2288 ± 1076ml vs 3450 ± 1176 ml, p: 0.000). and PaO 2 (75.4 ± 10.4 mmHg vs. 85.7 ± 9.5 mmHg, p = 0.001). Conclusions Lung volume reduction appears to be a predictive factor for PMV after LTx. Patients who required PMV have a significantly decreased survival and a poorer lung function than controls at 1 year post-transplant.