Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Eosinófilos/patología , Granulomatosis con Poliangitis/diagnóstico , Granulomatosis con Poliangitis/tratamiento farmacológico , Adulto , Anticuerpos Monoclonales Humanizados/farmacología , Biomarcadores , Biopsia , Femenino , Granulomatosis con Poliangitis/etiología , Granulomatosis con Poliangitis/metabolismo , Humanos , Inmunoglobulina E/inmunología , Masculino , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Patients with diffuse parenchymal lung disease (DPLD) have the poorest survival rates both before and after lung transplantation (LT). Early mortality among LT patients as a result of DLPD is estimated at 10% to 20%. The aim of the study was to assess intrahospital mortality after LT procedures for DLPD and to identify factors in the recipient, donor, intra- and postoperative periods that might improve early outcomes. METHODS: A retrospective, observational, cohort, single-hospital study was conducted. Data from 67 patients with LT patients owing to DPLD were recorded between October 2008 to June 2017 in Madrid, Spain. RESULTS: Out of 67 LT recipients with DPLD, 51 had idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP), 6 nonspecific interstitial pneumonia (NSIP), and 10 other DPLD. Intrahospital mortality took place in 13.4% of patients, with a median survival time of 34 days (interquartile range [IQR], 27.50-66). In the preoperative period, there were no differences in the recipients' demographic and hemodynamic characteristics, respiratory function, or time spent in the waiting list, except higher doses of systemic steroids in nonsurvivors (prednisone 15 vs 10 mg, P = .046). No differences were reported in the donors' characteristics (age, mechanical ventilation hours, PaO2/FiO2). In the intraoperative and postoperative periods, we found differences statistically significant in longer cold ischemia time and development of primary graft dysfunction (PGD) grade 3 in the nonsurvivor group. CONCLUSIONS: The mortality rate in our series was 13.4%, and the main risk factors for intrahospital mortality were longer cold ischemia time and greater incidence of PGD grade 3.
Asunto(s)
Enfermedades Pulmonares Intersticiales/mortalidad , Trasplante de Pulmón/mortalidad , Adulto , Estudios de Cohortes , Isquemia Fría/efectos adversos , Femenino , Humanos , Incidencia , Enfermedades Pulmonares Intersticiales/cirugía , Masculino , Persona de Mediana Edad , Disfunción Primaria del Injerto/epidemiología , Disfunción Primaria del Injerto/mortalidad , Estudios Retrospectivos , Factores de Riesgo , EspañaRESUMEN
BACKGROUND: Pulmonary hypertension (PH) is a comorbidity associated with interstitial lung disease (ILD). The purpose of this study was to evaluate the influence of PH on intrahospital mortality in lung transplantation (LT) for ILD. METHODS: We conducted a retrospective cohort study of 66 patients who underwent LT for ILD at the 12 de Octubre University Hospital (Madrid, Spain) from October 2008 to June 2014. PH was defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg on right-sided heart catheterization and intrahospital mortality as any death taken place after the transplantation of patients not being discharged. RESULTS: We retrospectively analyzed data of 66 patients; they were stratified by the presence or absence of PH before LT. Twenty-seven patients (41%) had PH. The PH group had a lower diffusing capacity of carbon monoxide (DLCO), carbon monoxide transfer coefficient (KCO), and 6-minute walk distance test (6MWT) and a higher total lung capacity (TLC), modified medical research council dyspnea scale (mMRC), and lung allocation score (LAS) than the non-PH group. Patients with PH more often underwent double lung transplantation (DLT; 59%) than single lung transplantation (SLT). Intrahospital mortality was 13% (9/66). No significant differences were observed in Kaplan-Meier survival curves for the PH and non-PH groups with a median survival time of 46 days versus 33 days (IQR 26-74; log-rank P = .056); however, the postoperative length of stay in the hospital was greater in the PH group. CONCLUSIONS: In our cohort, pulmonary hypertension was not related to early mortality in lung transplantation recipients for interstitial lung diseases.