Analysis of early deaths after isolated lung transplantation

Study objectives: To determine the causes of death in patients dying within 30 days after lung transplantation at the University of Florida, to assess the importance of several diagnostic modalities for determining the causes of their decline, and to construct an algorithm for the evaluation of pati ents with severe respiratory compromise occurring early after lung transpla ntation. Design: Retrospective review of medical records and pathology slides from a ll patients dying within 30 days after lung transplantation, and biopsy spe cimen diagnoses from all lung allograft recipients at the University of Flo rida, Patients: Nine deaths occurred during the first 30 days after transplantati on among 117 patients undergoing 123 isolated lung transplantation operatio ns. Results: Infections accounted for the greatest number of deaths (bacterial pneumonia, four patients; catheter-related bacteremia, one patient). Persis tent pneumonia confirmed by biopsy specimen was usually accompanied by hist ologic manifestations of acute cellular rejection and was associated with p oor patient outcome tie, death or subsequent development of bronchiolitis o bliterans syndrome). In two patients, antibody-mediated rejection either wa s the immediate cause of death (hyperacute rejection, one patient) or prece ded a fatal case of pneumonia (accelerated antibody-mediated rejection, one patient). Other causes of death included hypoxic-ischemic encephalopathy s econdary to an intraoperative cardiac arrest tone patient), pulmonary venou s thrombosis with bacterial colonization of the thrombotic material tone pa tient), and ischemic reperfusion injury (one patient). In most patients, mo re than one type of diagnostic technique was needed to ascertain the cause of the catastrophic decline. Conclusions: The causes of early posttransplant death in our patient group included infections, antibody-mediated rejection, hypoxic-ischemic encephal opathy secondary to cardiac arrest, pulmonary venous thrombosis, and ischem ic reperfusion injury. Because these processes often demonstrate overlappin g clinical and morphologic features requiring multiple diagnostic technique s for resolution, a systematic multimodality) approach to diagnosis is adva ntageous for determining the causes of decline in individual patients and f or estimating the incidences of the different causes of early graft and pat ient loss in the lung transplant population.