Neurocognitive Changes after Lung Transplantation

Smith, Patrick J.; Rivelli, Sara; Waters, Alexa; Reynolds, John M.; Hoyle, Amelia; Flowers, Miranda; Davis, Robert D.; Palmer, Scott M.; Mathew, Joseph P.; Durheim, Michael T.; Blumenthal, James A.

doi:10.1513/annalsats.201406-232oc

Cited by 49 publications

(46 citation statements)

References 40 publications

(36 reference statements)

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“…Our LT-VLA data and recent investigations focused on other individual health domains important in lung transplantation ( e.g ., depression and anxiety(9, 10, 14, 19, 21), physical functioning/disability(12, 17, 28), symptom burden(16, 18), and cognitive impairment(13, 15, 22)) suggest that increased attention to individual health domains may ultimately yield more informative data that can be used to design interventions to improve HRQL.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Lung Transplantation on Health-Related Quality of Life in the Era of the Lung Allocation Score: A U.S. Prospective Cohort Study

Singer

Katz

Soong

et al. 2017

American Journal of Transplantation

100

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Under the U.S. Lung Allocation Score (LAS) system, older and sicker patients are prioritized for lung transplantation (LT). The impact of these changes on health-related quality of life (HRQL) after transplant has not been determined. In a single-center prospective cohort study, from 2010–2016 we assessed HRQL before and repeatedly after LT for up to 3 years using the SF12-Physical and Mental Health, the respiratory-specific Airway Questionnaire 20-Revised, and the Euroqol 5D/Visual Analog Scale utility measures by multivariate linear mixed models jointly modeled with death. We also tested changes in LT-Valued Life Activities disability, BMI, allograft function, and 6-minute walk test exercise capacity as predictors of HRQL change. Amongst 211 initial participants (92% of those eligible), LT improved HRQL by all five measures (p<0.05) and all but SF12-Mental Health improved by three-fold or greater than the minimally clinically important difference. Compared to younger participants, those aged ≥65 improved less in SF12-Physical and Mental Health (p<0.01). Improvements in disability accounted for much of the HRQL improvement. In the LAS era, LT affords meaningful and durable HRQL improvements, mediated by amelioration of disability. Identifying factors limiting HRQL improvement in selected subgroups, especially those aged ≥65, are needed to maximize the net-benefits of LT.

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Section: Discussionmentioning

confidence: 99%

“…(9–22) Nonetheless, relatively few studies focused on HRQL itself as a primary outcome in lung transplantation have been published since the LAS overhaul. (23) Thus, given the clinical primacy of HRQL, there is a need for contemporary information on the effect of lung transplantation on general and respiratory-specific HRQL…”

Section: Introductionmentioning

confidence: 99%

Effect of Lung Transplantation on Health-Related Quality of Life in the Era of the Lung Allocation Score: A U.S. Prospective Cohort Study

Singer

Katz

Soong

et al. 2017

American Journal of Transplantation

100

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“…In addition, lower cerebral perfusion pressure was found to be associated with doubling the risk of delirium in the same patient sample, as well as increasing the duration and severity of delirium 12 . Finally, delirium during the index hospitalization in lung transplant recipients without cystic fibrosis has been associated with worse post-transplant neurocognitive function 13 .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…Delirium is common following lung transplant and has been shown to be associated with poorer clinical outcomes (8) and future cognitive impairment (9). Several recent studies have suggested that poorer intraoperative hemodynamic function may be associated with adverse neurocognitive outcomes among patients undergoing surgical procedures requiring single-lung ventilation (10,11).…”

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Reduced Cerebral Perfusion Pressure during Lung Transplant Surgery Is Associated with Risk, Duration, and Severity of Postoperative Delirium

et al. 2016

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Rationale: Delirium is common following lung transplant and is associated with poorer clinical outcomes. The extent to which intraoperative hemodynamic alterations may contribute to postoperative delirium among lung transplant recipients has not been examined. Objectives:To examine the impact of intraoperative hemodynamic changes on neurobehavioral outcomes among lung transplant recipients.Methods: Intraoperative hemodynamic function during lung transplant was assessed in a consecutive series of patients between March and November 2013. Intraoperative cerebral perfusion pressure was assessed every minute in all patients. Following lung transplant, patients were monitored for the presence and severity of delirium using the Confusion Assessment Method and the Delirium Rating Scale until hospital discharge.Measurements and Main Results: Sixty-three patients received lung transplants, of whom 23 (37%) subsequently developed delirium. Lower cerebral perfusion pressure was associated with increased risk of delirium (odds ratio [OR], 2.08 per 10-mm Hg decrease; 95% confidence interval [CI], 1.02-4.24; P = 0.043), longer duration of delirium (OR, 1.7 d longer per 10-mm Hg decrease; 95% CI, 1.1-2.7; P = 0.022), and greater delirium severity (b = 20.81; 95% CI, 21.47 to 20.15; P = 0.017).Conclusions: Poorer cerebral perfusion pressure during lung transplant is associated with greater risk for delirium following transplant, as well as greater duration and severity of delirium, independent of demographic and medical predictors. Author Contributions: Concept and design, J.A.B., S.K.R., R.D.D., S.M.P., J.P.M., and P.J.S. Data collection, P.J.S., J.P.M., B.M.H., and S.K.R. Analysis and interpretation of the data, P.J.S., J.P.M., and J.A.B. Drafting of the manuscript, P.J.S., J.P.M., S.M.P., and J.A.B. Critical revision of the article for important intellectual content, P

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Neurocognitive Changes after Lung Transplantation

Cited by 49 publications

References 40 publications

Effect of Lung Transplantation on Health-Related Quality of Life in the Era of the Lung Allocation Score: A U.S. Prospective Cohort Study

Effect of Lung Transplantation on Health-Related Quality of Life in the Era of the Lung Allocation Score: A U.S. Prospective Cohort Study

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

Reduced Cerebral Perfusion Pressure during Lung Transplant Surgery Is Associated with Risk, Duration, and Severity of Postoperative Delirium

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