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

https://doi.org/10.1111/j.1600-6143.2011.03684.xGet rights and content
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Lung transplantation in mechanically ventilated (MV) patients has been associated with decreased posttransplant 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 pretransplant MV is associated with poorer posttransplant survival in the LAS era. Using a national registry, we analyzed all adults undergoing lung transplantation in the United States from 2005 to 2010. Propensity scoring identified nonventilated 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 pretransplant MV was associated with decreased overall survival after lung transplantation. In the first 6 months posttransplant, ventilated subjects had a twofold higher risk of death compared to nonventilated subjects. However, after 6 months posttransplant, survival did not differ by MV status. We also found that pretransplant MV was not associated with decreased survival in noncystic fibrosis obstructive lung diseases. These results suggest that under the LAS, pretransplant MV is associated with poorer short-term survival posttransplant. Notably, the increased risk of death appears to be strongest the early posttransplant period and limited to certain pretransplant diagnoses.

Key words:

Artificial respiration
lung allocation score
lung transplantation
survival
propensity score

Abbreviations:

IPF
Idiopathic pulmonary fibrosis
OPTN
Organ Procurement and Transplantation Network
LAS
Lung Allocation Score
FEV1
% predicted forced expiratory volume in 1 second
pCO2
arterial blood gas partial pressure of carbon dioxide
SSMDF
Social Security Master Death File
ECMO
extracorporeal membrane oxygenation
UNOS
United Network for Organ Sharing

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