PULMONARY REIMPLANTATION RESPONSE IN SINGLE-LUNG TRANSPLANTATION

We studied the characteristics of the pulmonary reimplantation respons e (PRR) in single-lung transplantation (SLT), and detailed the occurre nce, evolution, prognosis and risk factors of this complication. Forty single-lung transplant recipients were studied, Twenty four patients developed hypoxaemia and allograft infiltrates consistent with the PRR . In 40% of the cases hypoxaemia was severe, precluding weaning and re quiring prolonged mechanical ventilation with high fractional inspirat ory oxygen (Fro,), The mean duration of ventilation was 7 days (range 1-19 days), Clearing of the chest radiographs was progressive, with co mplete resolution between 6 and 21 days. In all cases, the pulmonary a rterial wedge pressure was normal (6+/-2 mmHg) suggesting low pressure oedema. Sampling of the pulmonary oedema fluid revealed that the rati o of protein concentration in oedema fluid to that in serum exceeded 0 .5. In patients with severe PRR (40% of cases) clinical, radiographic and haemodynamic abnormalities were identical to adult respiratory dis tress syndrome (ARDS), but the prognosis was more favourable with no d eath directly related to PRR in our patients. The mean duration of gra ft ischaemia of the oedematous grafts (241+/-103 min) was significantl y longer than that of nonoedematous grafts (155+/-71 min). These date suggest that prolongation of graft ischaemia increased the incidence o f PRR.