Barbara C S Hamilton1, Gabriela R Dincheva2, Michael A Matthay3, Steven Hays4, Jonathan P Singer4, Marek Brzezinski5, Jasleen Kukreja2. 1. Department of Surgery, University of California San Francisco, San Francisco, Calif. Electronic address: Barbara.hamilton@ucsf.edu. 2. Department of Surgery, University of California San Francisco, San Francisco, Calif. 3. Department of Medicine, Anesthesia and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, Calif. 4. Department of Medicine, Pulmonary and Critical Care, University of California San Francisco, San Francisco, Calif. 5. Department of Anesthesia, University of California San Francisco, San Francisco, Calif.
Abstract
OBJECTIVE: Early survival after lung transplantation has improved in the last decade. Mechanically ventilated recipients are known to be at greater risk for early post-transplant mortality. We hypothesized that post-transplant survival in mechanically ventilated recipients has improved over time. METHODS: Using a national registry, we compared hazard of death at 30 days, 4 and 14 months, 3 and 5 years, and overall for adults on mechanical ventilation who underwent lung or heart-lung transplantation from May 4, 2011, to April 4, 2018 (modern group) with those undergoing transplantation from May 4, 2005, to May 3, 2011 (early group). We quantified the impact of mechanical ventilation on survival using population-attributable fractions. We also compared mechanically ventilated recipients with nonmechanically ventilated recipients. RESULTS: Mechanically ventilated recipients from the modern group had lower hazard of death than recipients in the early group at all time-points, lowest at 30-days post-transplant (hazard ratio, 0.04; 95% confidence interval, 0.02-0.08). In the modern period, mechanically ventilated recipients had greater hazard of death than nonmechanically ventilated recipients at 30 days' post-transplant (9.53; 4.57-19.86). For mechanically ventilated recipients, the population attributable fraction was lower in the modern group compared to the earlier group (0.6% vs 5.7%). CONCLUSIONS: While mechanically ventilated recipients remain at high risk, survival in this patient population has improved over time. This may reflect improvements in perioperative recipient management.
OBJECTIVE: Early survival after lung transplantation has improved in the last decade. Mechanically ventilated recipients are known to be at greater risk for early post-transplant mortality. We hypothesized that post-transplant survival in mechanically ventilated recipients has improved over time. METHODS: Using a national registry, we compared hazard of death at 30 days, 4 and 14 months, 3 and 5 years, and overall for adults on mechanical ventilation who underwent lung or heart-lung transplantation from May 4, 2011, to April 4, 2018 (modern group) with those undergoing transplantation from May 4, 2005, to May 3, 2011 (early group). We quantified the impact of mechanical ventilation on survival using population-attributable fractions. We also compared mechanically ventilated recipients with nonmechanically ventilated recipients. RESULTS: Mechanically ventilated recipients from the modern group had lower hazard of death than recipients in the early group at all time-points, lowest at 30-days post-transplant (hazard ratio, 0.04; 95% confidence interval, 0.02-0.08). In the modern period, mechanically ventilated recipients had greater hazard of death than nonmechanically ventilated recipients at 30 days' post-transplant (9.53; 4.57-19.86). For mechanically ventilated recipients, the population attributable fraction was lower in the modern group compared to the earlier group (0.6% vs 5.7%). CONCLUSIONS: While mechanically ventilated recipients remain at high risk, survival in this patient population has improved over time. This may reflect improvements in perioperative recipient management.
Authors: J P Singer; P D Blanc; C Hoopes; J A Golden; J L Koff; L E Leard; S Cheng; H Chen Journal: Am J Transplant Date: 2011-08-10 Impact factor: 8.086
Authors: J Wytze Vermeijden; Jan G Zijlstra; Michiel E Erasmus; Wim van der Bij; Erik A Verschuuren Journal: J Heart Lung Transplant Date: 2009-04 Impact factor: 10.247
Authors: M Rocco; G Conti; M Antonelli; M Bufi; M G Costa; D Alampi; F Ruberto; G V Stazi; P Pietropaoli Journal: Intensive Care Med Date: 2001-10 Impact factor: 17.440
Authors: Mauer Biscotti; Whitney D Gannon; Cara Agerstrand; Darryl Abrams; Joshua Sonett; Daniel Brodie; Matthew Bacchetta Journal: Ann Thorac Surg Date: 2017-02-24 Impact factor: 4.330
Authors: David P Mason; Lucy Thuita; Edward R Nowicki; Sudish C Murthy; Gösta B Pettersson; Eugene H Blackstone Journal: J Thorac Cardiovasc Surg Date: 2010-03 Impact factor: 5.209
Authors: J M Schaenman; F Rosso; J M Austin; E J Baron; P Gamberg; J Miller; P E Oyer; R C Robbins; J G Montoya Journal: Transpl Infect Dis Date: 2009-04 Impact factor: 2.228