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Risk factors for reperfusion injury after lung transplantation

Cottini, Silvia ; Lerch, Nicolas ; de Perrot, Marc ; Treggiari, Miriam ; Spiliopoulos, Anastase ; Nicod, Laurent ; Ricou, Bara

In: Intensive Care Medicine, 2006, vol. 32, no. 4, p. 557-563

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    Titre
    • Risk factors for reperfusion injury after lung transplantation
    Auteur
    • Cottini, Silvia. Division of Surgical Intensive Care, Department of Anesthesiology, Pharmacology and Surgical Intensive Care, University Hospital of Geneva, Geneva, Switzerland
    • Lerch, Nicolas. Division of Surgical Intensive Care, Department of Anesthesiology, Pharmacology and Surgical Intensive Care, University Hospital of Geneva, Geneva, Switzerland
    • de Perrot, Marc. Clinic of Thoracic Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
    • Treggiari, Miriam. Department of Anesthesiology, University of Washington, Seattle, WA,, USA
    • Spiliopoulos, Anastase. Clinic of Thoracic Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
    • Nicod, Laurent. Division of Pulmonary Medicine, Department of Internal Medicine, University Hospital of Geneva, Geneva, Switzerland
    • Ricou, Bara. Division of Surgical Intensive Care, Department of Anesthesiology, Pharmacology and Surgical Intensive Care, University Hospital of Geneva, Geneva, Switzerland
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:317839
    Summary
    Objective: To assess the influence of recipient's and donor's factors as well as surgical events on the occurrence of reperfusion injury after lung transplantation. Design and setting: Retrospective study in the surgical intensive care unit (ICU) of auniversity hospital. Methods: We collected data on 60 lung transplantation donor/recipient pairs from June1993 to May2001, and compared the demographic, peri- and postoperative variables of patients who experienced reperfusion injury (35%) and those who did not. Results: The occurrence of high systolic pulmonary pressure immediately after transplantation and/or its persistence during the first 48 h after surgery was associated with reperfusion injury, independently of preoperative values. Reperfusion injury was associated with difficult hemostasis during transplantation (p = 0.03). Patients with reperfusion injury were more likely to require the administration of catecholamine during the first 48 h after surgery (p = 0.014). The extubation was delayed (p = 0.03) and the relative odds of ICU mortality were significantly greater (OR 4.8, 95% CI: 1.06, 21.8) in patients with reperfusion injury. Our analysis confirmed that preexisting pulmonary hypertension increased the incidence of reperfusion injury (p < 0.01). Conclusions: Difficulties in perioperative hemostasis were associated with reperfusion injury. Occurrence of reperfusion injury was associated with postoperative systolic pulmonary hypertension, longer mechanical ventilation and higher mortality. Whether early recognition and treatment of pulmonary hypertension during transplantation can prevent the occurrence of reperfusion injury needs to be investigated