Lung transplantation after long-term mechanical ventilation - Results and 1-year follow-up

Background: Long-term mechanical ventilation is considered as a relative or absolute contraindication for lung transplantation by most centers. We rep ort on the results of transplantation in nine patients requiring long-term mechanical ventilation at two lung transplant centers. Methods: The study group (group 1) consisted of nine patients receiving mec hanical ventilation who underwent lung transplantation at either Duke Unive rsity Medical Center or the University of Florida between 1992 and 1997. Pa tients in group 1 met the following criteria: they underwent exercise thera py with a physical therapist, and they mere without panresistant bacterial airway colonization. The study patients that met these criteria spent at le ast 13 days receiving mechanical ventilation prior to transplantation. The control population (group 2; n = 65) consisted of all patients who underwen t transplantation at either center in the calendar year 1997 who were venti lator independent. The 1-year survival rates in each group were calculated by the Kaplan-Meier method. The number of days required for extubation in e ach group were compared by the nonparametric Wilcoxon rank sum test. The FE V1 value at 1 year was reported in each group. Results: The 1-year survival rates were 78% and 83% in group 1 and group 2, respectively. The mean number of days required until extubation were 41 da ys in group 1 and 9 days in group 2 (p < 0.01), The allograft function was comparable in the two groups at 1 year. Conclusions: In a select population of ventilator-dependent patients, the 1 -year survival rate is comparable to the standard lung transplant populatio n. However, these ventilator-dependent patients require a significantly lon ger time until extubation than other transplant recipients.