Are heart-lung transplant recipients protected from developing transplant coronary artery disease? A case-matched intracoronary ultrasound study

Determinants of health utility in lung and heart-lung transplant recipients

Bronchiolitis obliterans syndrome (BOS) is associated with poor health-related quality of life (HRQL) following lung and heart-lung transplantation, but few other determinants of HRQL have been described. We performed a cross-sectional study of standard gamble utility, a preference-based measure of HRQL, in 90 stable lung and heart-lung transplant recipients. We used bivariate analyses and multiple linear regression to evaluate associations between utility scores and candidate predictor variables including age, sex, indication for transplant (obstructive, interstitial, suppurative and pulmonary vascular diseases), transplant type (bilateral, single and heart-lung), time since transplant, body mass index, arterial PO(2), creatinine clearance, number of medications, presence of BOS and risk-attitude score. The median utility was 0.88 (inter-quartile range: 0.50-0.99). Multivariable analysis showed that female sex, absence of BOS, better renal function and longer time since transplantation were associated with higher utility scores, and that there were utility differences across diagnostic groups. Although BOS is a major determinant of utility following lung and heart-lung transplantation, other demographic and clinical factors are also associated with significant differences in this measure of HRQL.

Previous thoracic surgery does not increase peri-operative mortality in pediatric heart-lung transplant recipients

BACKGROUND

Heart-lung transplant (HLT) is indicated in select children with end-stage cardiopulmonary disease. We sought to determine whether previous thoracic surgery increases peri-operative morbidity and mortality.

METHODS

Retrospective data were analyzed using unpaired Student's t-test and Fisher's exact test. Results are reported as mean +/- SD. Peri-operative mortality was defined as death at </=30 days post-transplant.

RESULTS

From August 1993 through April 2001, 13 patients (mean age 7.9 +/- 5.3 years; 9 girls, 4 boys) underwent HLT at our center. Eight of 13 (62%) had previous thoracic surgery and 5 of 13 (38%) did not. Interval of last surgery to transplant date was 45.5 +/- 26.4 months (range 6 to 79 months). We compared HLT patients who had previous thoracic surgery to HLT recipients who did not. There was no significant difference in weight (18.6 +/- 14.3 vs 36.5 +/- 20.7 kg, p = 0.09), age (6.5 +/- 4.5 vs 10.2 +/- 6.1 years, p = 0.23) or duration of intubation (14.1 +/- 12.9 vs 17.0 +/- 30.3 days, p = 0.83). There were no caval or tracheal anastomotic stenoses in either group. There was no significant difference in blood products transfused </=48 hours after HLT: packed red blood cells (p = 0.16); fresh frozen plasma (p = 0.13); platelets (p = 0.59), and cryoprecipitate (p = 0.27). There was no difference in cardiopulmonary bypass time (129.3 +/- 48.2 vs 160.6 +/- 73.9 minutes, p 0.39); post-operative diaphragm dysfunction (4 of 8 vs 0 of 5, p = 0.1); re-exploration for bleeding (2 of 8 vs 1 of 5, p = 1.0); or peri-operative mortality (2 of 8 vs 0 of 5, p = 0.48).

CONCLUSIONS

We conclude that previous thoracic surgery in HLT recipients does not significantly increase blood product transfusion, cardiopulmonary bypass time or peri-operative mortality.