Objectives
Even after transplantation of favourable donor lungs, some recipients require prolonged weaning from mechanical ventilation, indicating a poor prognosis. We investigated the effects of prolonged mechanical ventilation for ≥14 days on the recovery and survival of patients who underwent cadaveric lung transplantation in relation to their physical traits.
Methods
We retrospectively reviewed patients who underwent cadaveric lung transplantation (age ≥15 years) at a single center between April 2015 and December 2020 and classified them into prolonged mechanical ventilation and non-prolonged mechanical ventilation groups (≥14 and <14 days of mechanical ventilation postoperatively, respectively). The factors predicting prolonged mechanical ventilation comprised clinical factors (e.g., marginal donor) and physical features, namely flat chest, narrow fourth intercostal space (length, <5 mm), mediastinal shift, thoracic mediastinal-occupying ratio >40%, and sarcopenia, according to the logistic regression analysis. The log-rank test was used to examine the association between thoracic mediastinal-occupying ratio >40% and 3-year prognosis.
Results
The prolonged mechanical ventilation group comprised 17 (33%) of 51 recipients. Multivariable logistic analysis showed that the thoracic mediastinal-occupying ratio >40% (odds ratio, 7.3; 95% confidence interval, 1.3–40.1; P =0.023) was an independent preoperative predictive factor for prolonged mechanical ventilation postoperatively. Stepwise analysis revealed intraoperative extracorporeal membrane oxygenation and reoperation as postoperative predictive factors in addition to thoracic mediastinal-occupying ratio >40%. Recipients with thoracic mediastinal-occupying ratio >40% had significantly worse 3-year survival than other recipients (71.2% vs 100.0%, respectively; P =0.008).
Conclusions
Recipients with a thoracic mediastinal-occupying ratio >40% may be long-term ventilator-dependent and have a poor prognosis.