Medical Complications in Lung Transplant Patients – Autopsy Data from a Single Center
Z Hu, Y Li, J Gagermeier, R Love, C Alex, M Picken. Loyola Univ Med Ctr, Maywood
Background: Although lung transplantion (tx) has become an established treatment for end stage lung disease, and patient survival continues to improve, deaths from medical complications post lung tx are still relatively high.
Design: To better understand the role of rejection and infection in the mortality of lung tx patients, we reviewed the autopsy findings over 17 years from a single lung tx center. We grouped the patients into 2 cohorts depending on the date of death: 1991-99, and 2000-09. We compared the incidence of infection versus rejection in the 2 groups.
Results: Autopsy findings from 71 lung tx patients [27 females (38%), 44 males (62%)] were analyzed. The pre-tx diseases included: α1 antitrypsin deficiency/chronic obstructive pulmonary disease (41%), cystic fibrosis (21%), idiopathic pulmonary fibrosis (23%). Post lung tx, the main cause of death within <1 month was bacterial infection, during >1 month to <3 months was viral/fungal infection, and threreafter (>3 mo.) chronic rejection.
The predominant bacterial pathogens were Enterococci and Pseudomonas spp. (n=19, 86%). The main viral pathogen was CMV (n=16, 80%), and fungal pathogens were Candida (n=10, 50%) and Aspergillus (n=8, 40%). Deaths from infection/sepsis continued to remain high in the 2000s, with the same %-age as in the 1990s.
However, the timing of death from infection post-tx shifted. While in the 90s, 71% of deaths from infection occurred in <6 months, in the 2000s only 21% occurred during that time. In the most recent decade, in the patient population studied, deaths from chronic rejection have been diagnosed at autopsy less frequently (p<0.05).
Conclusions: Infections continue to be the main cause of death in lung tx recipients. The reduction in the incidence of diagnosis of chronic rejection at autopsy may be related to the shift in long-term post-tx care (from tertiary to primary) and a reduced rate of autopsy in these patients.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 11, Wednesday Morning