Transplant Procurement Dept, Vall d'Hebron University Hospital, Barcelona, Spain
Vall d'Hebron Research Institute, Barcelona, Spain.
Eur Respir J. 2019 Oct 1;54(3). doi: 10.1183/13993003.01512-2018. Print 2019 Sep.
We aimed to assess the main causes of intensive care unit (ICU) readmissions in lung transplant adults and to identify independent predictors of ICU mortality (primary end-point).This Spanish five-centre prospective cohort study enrolled all lung transplant adults with ICU readmissions after post-transplant ICU discharge between 2012 and 2016. Patients were followed until hospital discharge or death.153 lung transplant recipients presented 174 ICU readmissions at a median (interquartile range) of 6 (2-25) months post-transplant. Chronic lung allograft dysfunction was reported in 39 (25.5%) recipients, 13 of whom (all exitus) had restrictive allograft syndrome (RAS). Acute respiratory failure (ARF) (110 (71.9%)) was the main condition requiring ICU readmission. Graft rejection (six (5.4%) acute) caused only 12 (10.8%) readmissions whereas pneumonia (56 (36.6%)) was the main cause (50 admitted for ARF and six for shock), with (50% multidrug resistant) being the predominant pathogen. 55 (35.9%) and 69 (45.1%) recipients died in the ICU and the hospital, respectively. Bronchiolitis obliterans syndrome (BOS) stage 2 (adjusted OR (aOR) 7.2 (95% CI 1.0-65.7)), BOS stage 3 (aOR 13.7 (95% CI 2.5-95.3)), RAS (aOR >50) and pneumonia at ICU readmission (aOR 2.5 (95% CI 1.0-7.1)) were identified in multivariate analyses as independent predictors of ICU mortality. Only eight (5.2%) patients had positive donor-specific antibodies prior to ICU readmission and this variable did not affect the model.ARF was the main condition requiring ICU readmission in lung transplant recipients and was associated with high mortality. Pneumonia was the main cause of death and was also an independent predictor. RAS should receive palliative care rather than ICU admission.
我们旨在评估成人肺移植后 ICU 再入院的主要原因，并确定 ICU 死亡率的独立预测因素（主要终点）。这项西班牙五中心前瞻性队列研究纳入了 2012 年至 2016 年间肺移植后 ICU 出院后 ICU 再入院的所有成人肺移植患者。患者随访至出院或死亡。153 例肺移植受者在移植后中位（四分位间距）6（2-25）个月时发生 174 例 ICU 再入院。39 例（25.5%）受者报告有慢性肺移植物功能障碍，其中 13 例（均死亡）有限制性移植物综合征（RAS）。急性呼吸衰竭（ARF）（110 例（71.9%））是需要 ICU 再入院的主要病症。排斥反应（6 例（5.4%）急性）仅导致 12 例（10.8%）再入院，而肺炎（56 例（36.6%））是主要原因（50 例因 ARF 入院，6 例因休克入院），其中（50%为多药耐药菌）是主要病原体。分别有 55 例（35.9%）和 69 例（45.1%）受者在 ICU 和医院死亡。在多变量分析中，闭塞性细支气管炎综合征（BOS）2 期（调整后的比值比（aOR）7.2（95%CI 1.0-65.7））、BOS 3 期（aOR 13.7（95%CI 2.5-95.3））、RAS（aOR>50）和 ICU 再入院时肺炎（aOR 2.5（95%CI 1.0-7.1））被确定为 ICU 死亡率的独立预测因素。仅 8 例（5.2%）患者在 ICU 再入院前有阳性供体特异性抗体，该变量未影响模型。ARF 是肺移植受者需要 ICU 再入院的主要病症，与高死亡率相关。肺炎是死亡的主要原因，也是独立的预测因素。RAS 应接受姑息治疗，而不是 ICU 入院。
