Prolonged mechanical ventilation after lung transplantation: risks factors and consequences on recipient outcome

Enora Atchade; Aimane Boughaba; Alexy Tran Dinh; Sylvain Jean-Baptiste; Sébastien Tanaka; Léa Copelovici; Brice Lortat-Jacob; Arnaud Roussel; Yves Castier; Jonathan Messika; Hervé Mal; Christian de Tymowski; Philippe Montravers

doi:10.3389/fmed.2023.1160621

Prolonged mechanical ventilation after lung transplantation: risks factors and consequences on recipient outcome

Front Med (Lausanne). 2023 May 9:10:1160621. doi: 10.3389/fmed.2023.1160621. eCollection 2023.

Authors

Enora Atchade¹, Aimane Boughaba¹, Alexy Tran Dinh^{1

2

3}, Sylvain Jean-Baptiste¹, Sébastien Tanaka^{1

4}, Léa Copelovici¹, Brice Lortat-Jacob¹, Arnaud Roussel⁵, Yves Castier^{3

5

6}, Jonathan Messika^{3

7}, Hervé Mal^{3

6

7}, Christian de Tymowski^{1

8}, Philippe Montravers^{1

3

6}

Affiliations

¹ APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France.
² INSERM U1148, LVTS, CHU Bichat-Claude Bernard, Paris, France.
³ Université de Paris, UFR Diderot, Paris, France.
⁴ Université De La Réunion, INSERM UMR 1188, Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de la Réunion, France.
⁵ APHP, CHU Bichat-Claude Bernard, Service de Chirurgie Thoracique et Vasculaire, 46 rue Henri Huchard, Paris, France.
⁶ INSERM UMR 1152, Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France.
⁷ APHP, CHU Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France.
⁸ INSERM UMR 1149, Immunorecepteur et Immunopathologie Rénale, CHU Bichat-Claude Bernard, Paris, France.

Abstract

Background: Risk factors and the incidence of prolonged mechanical ventilation (PMV) after lung transplantation (LT) have been poorly described. The study assessed predictive factors of PMV after LT.

Methods: This observational, retrospective, monocentric study included all patients who received LT in Bichat Claude Bernard Hospital between January 2016 and December 2020. PMV was defined as a duration of MV > 14 days. Independent risk factors for PMV were studied using multivariate analysis. One-year survival depending on PMV was studied using Kaplan Meier and log-rank tests. A p value <0.05 was defined as significant.

Results: 224 LT recipients were analysed. 64 (28%) of them received PMV for a median duration of 34 [26-52] days versus 2 [1-3] days without PMV. Independent risk factors for PMV were higher body mass index (BMI) (p = 0.031), diabetes mellitus of the recipient (p = 0.039), ECMO support during surgery (p = 0.029) and intraoperative transfusion >5 red blood cell units (p < 0.001). Increased mortality rates were observed at one-year in recipients who received PMV (44% versus 15%, p < 0.001).

Conclusion: PMV was associated with increased morbidity and mortality one-year after LT. Preoperative risk factors (BMI and diabetes mellitus) must be considered when selecting and conditioning the recipients.

Keywords: intensive care unit; lung transplantation; one-year mortality; outcome; prolonged mechanical ventilation.