Delirium after lung transplantation: Association with recipient characteristics, hospital resource utilization, and mortality

Abstract

Background Delirium is associated with increased morbidity and mortality. The factors associated with post-lung transplant delirium and its impact on outcomes are under characterized. Methods The medical records of 163 consecutive adult lung transplant recipients were reviewed for delirium within 5 days (early-onset) and 30 hospital days (ever-onset) post-transplantation. A multivariable logistic regression model assessed factors associated with delirium. Multivariable negative binomial regression and Cox proportional hazards models assessed the association of delirium with ventilator duration, intensive care unit (ICU) length of stay (LOS), hospital LOS and one-year mortality. Results Thirty six % developed early-onset and 44% - ever-onset delirium. Obesity (OR 6.35, 95% CI 1.61–24.98) and bolused benzodiazepines within the first post-operative day (OR 2.28, 95% CI 1.07–4.89) were associated with early-onset delirium. Early-onset delirium was associated with longer adjusted mechanical ventilation duration (p=0.001), ICU LOS (p<0.001), and hospital LOS (p=0.005). Ever-onset delirium was associated with longer ICU (p<0.001) and hospital LOS (p<0.001). After adjusting for clinical variables, delirium was not significantly associated with one-year mortality (early-onset HR 1.65, 95% CI 0.67–4.03; ever-onset HR 1.70, 95% CI 0.63–4.55). Conclusions Delirium is common after lung transplant surgery and associated with increased hospital resources.

Neurological Sequelae and Clinical Outcomes After Lung Transplantation

“…These findings suggest that perioperative neurological events, particularly posttransplant delirium, are relatively common after lung transplantation affecting nearly half of patients undergoing lung transplantation, and are predictive of subsequent clinical outcomes. 6 - 8 These findings extend previous evidence suggesting that a substantial subset of patients experience significant neurological complications after transplant, 6 although the predictors of neurological events and clinical implications have not been thoroughly examined. 7 , 8 …”

“… 4 , 5 Despite the steady growth of lung transplantation and the increasing age of lung transplant recipients, relatively few studies have examined neurological sequelae after transplantation, 6 , 7 and available studies have been limited by small sample sizes, select patient groups, and a small range of neurological events examined. 8 In addition, neuroimaging correlates of neurological sequelae have yet to be characterized among lung transplant recipients.…”

Cerebral complications of solid organ transplantation

“…Postoperative delirium is a frequent complication of liver, heart and lung transplantation, occurring in 10%-36% of cases [3,[5][6][7], and seems to be less frequent after kidney transplantation [8]. In patients receiving liver transplantation for alcoholic liver disease, increased pre-transplantation serum level of ammonia and shorter duration of abstinence were identified as risk factors [9].…”

“…In patients receiving liver transplantation for alcoholic liver disease, increased pre-transplantation serum level of ammonia and shorter duration of abstinence were identified as risk factors [9]. Data in liver and lung transplant recipients suggest that obesity, pretransplant acute kidney injury, intraoperative complications and benzodiazepine exposure are important risk factors [5][6][7]. Postoperative delirium is associated with adverse outcome, including increased use of hospital resources, graft rejection and mortality.…”

Levosimendan in lung transplant recipients on VA‑ECMO

“…В настоящее время, по данным Российского трансплантологического общества (РТО), ТЛ осуществляется в 4 центрах [4]. В НИИ СП им.…”