Reimplantation disease in the postoperative phase of lung transplant. Incidence, predictive factors, prognosis and outcome

BACKGROUND: Reimplantation disease (RD) is a postoperative complication in lung transplantation. It is defined as hypoxemia (PaO2/FiO(2) ratio < 150 m mHg), radiologic infiltrates and decrease of lung compliance. The aim of th e study was to analyze the incidence, predictive factors, prognosis and out come of the patients with RD. PATIENTS AND METHOD: 49 patients submitted to lung transplantation (June 19 91-December 1996) were admitted in our intensive care unit (ICU). Donor and recipient conditions, surgical parameters and outcome in ICU were analyzed . Mann-Whitney, Kruskall-Wallis, Fisher, Pearson and ANOVA-Friedman tests w ere used for statistical analysis acording to the different variables. RESULTS: 49% Of the patients (29/49) developed RD, which was influenced nei ther by lung disease, nor by the kind of transplantation or by ischemia tim e. All patients with a long surgical time developed RD, versus only 41% in those where surgery was undertaken in a shorter period of time, OR: 2.8 (1. 5-5.7; p = 0.0016). The patients with RD improved showing a PaO2/FiO(2) rat io of 176 and 235 mmHg at 24 and 48 h respectively (ANOVA, p < 0.00001). Th e patients with RD needed 14 days of mechanical ventilation versus 7 days i n those without RD (p = 0.013). There were no statistically significant dif ferences in stay and mortality in ICU. CONCLUSIONS: RD is a common complication in the postoperative phase of lung transplantation. It is present in almost all the patients with long surgic al time. Almost all of them improve, with the same survival but a longer pe riod of mechanical ventilation.