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Preoperative Trapped Lung Is Associated with Increased Mortality After Orthotopic Liver Transplantation
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A4226 - Preoperative Trapped Lung Is Associated with Increased Mortality After Orthotopic Liver Transplantation
Author Block: K. Melamed1, D. Dai2, N. Cuk2, R. Follett3, T. S. Wang1, F. Kaldas4, A. S. Shirali5, J. Yanagawa5, I. Barjaktarevic1; 1Pulmonary and Critical Care Medicine, UCLA, Los Angeles, CA, United States, 2Department of Medicine, UCLA, Los Angeles, CA, United States, 3UCLA Clinical and Translational Science Institute, UCLA, Los Angeles, CA, United States, 4Division of Liver and Pancreas Transplantation, UCLA, Los Angeles, CA, United States, 5Division of Thoracic Surgery, UCLA, Los Angeles, CA, United States.
RATIONALE: Trapped lung (TL), characterized by the inability of the lung to expand and fill the thoracic cavity due to a restricting fibrous visceral pleural peel, is occasionally seen in patients with end-stage liver disease (ESLD) complicated by hepatic hydrothorax. Although the incidence and clinical significance of TL in this population is not well described, limited data suggest that the presence of TL prior to the orthotopic liver transplantation (OLT) may be associated with poor clinical outcomes. Here, we describe the largest cohort to date of patients with ESLD and preoperative TL who underwent OLT.
METHODS: We performed a retrospective chart review of patients who underwent OLT between January 2006 and June 2017 at UCLA Medical Center. Adults with documentation of TL prior to receiving OLT were included in the analysis. TL was defined as a lung that does not fully expand after drainage, leaving a pneumothorax ex-vacuo or hydropneumothorax, or as a chronically atelectatic lung with thickened pleura and evidence of ipsilateral hemithorax volume loss. Demographic, clinical, laboratory, imaging, and outcomes data were analyzed and compared between this cohort and overall population of transplanted patients.
RESULTS: Of the 1963 patients who underwent OLT from January 2006 through June 2017, we identified 20 patients (1.01%) with TL prior to the OLT. This cohort was 70% male with an average age of 57 years and an average MELD score of 36. The TL was most often right-sided (70%), and the majority of effusions surrounding the TL were transudates (75%). In 80% of the cases, the pleural fluid was sampled via thoracentesis and/or tube thoracostomy. The 1-year and 3-year mortality rates were 25.0% and 40.0% respectively, compared to 14.6% 1-year and 21.6% 3-year mortality rates in overall population of OLT recipients at our institution. In comparison to the overall population of OLT recipients, whose average postoperative length of stay was 34 days, our cohort spent an average of 73 days in the hospital after OLT on the index admission, and had an average of 1.45 readmissions within the first calendar year post OLT.
CONCLUSIONS: Patients with TL prior to OLT have increased 1-year and 3-year mortality and health care utilization. Nevertheless, the actual clinical significance and recognition of other concomitant factors that predict poorer outcomes in this population are still largely missing. Further investigation should be focused on this population, with the goal of improving postoperative liver transplantation outcomes and survival.
Author Block: K. Melamed1, D. Dai2, N. Cuk2, R. Follett3, T. S. Wang1, F. Kaldas4, A. S. Shirali5, J. Yanagawa5, I. Barjaktarevic1; 1Pulmonary and Critical Care Medicine, UCLA, Los Angeles, CA, United States, 2Department of Medicine, UCLA, Los Angeles, CA, United States, 3UCLA Clinical and Translational Science Institute, UCLA, Los Angeles, CA, United States, 4Division of Liver and Pancreas Transplantation, UCLA, Los Angeles, CA, United States, 5Division of Thoracic Surgery, UCLA, Los Angeles, CA, United States.
RATIONALE: Trapped lung (TL), characterized by the inability of the lung to expand and fill the thoracic cavity due to a restricting fibrous visceral pleural peel, is occasionally seen in patients with end-stage liver disease (ESLD) complicated by hepatic hydrothorax. Although the incidence and clinical significance of TL in this population is not well described, limited data suggest that the presence of TL prior to the orthotopic liver transplantation (OLT) may be associated with poor clinical outcomes. Here, we describe the largest cohort to date of patients with ESLD and preoperative TL who underwent OLT.
METHODS: We performed a retrospective chart review of patients who underwent OLT between January 2006 and June 2017 at UCLA Medical Center. Adults with documentation of TL prior to receiving OLT were included in the analysis. TL was defined as a lung that does not fully expand after drainage, leaving a pneumothorax ex-vacuo or hydropneumothorax, or as a chronically atelectatic lung with thickened pleura and evidence of ipsilateral hemithorax volume loss. Demographic, clinical, laboratory, imaging, and outcomes data were analyzed and compared between this cohort and overall population of transplanted patients.
RESULTS: Of the 1963 patients who underwent OLT from January 2006 through June 2017, we identified 20 patients (1.01%) with TL prior to the OLT. This cohort was 70% male with an average age of 57 years and an average MELD score of 36. The TL was most often right-sided (70%), and the majority of effusions surrounding the TL were transudates (75%). In 80% of the cases, the pleural fluid was sampled via thoracentesis and/or tube thoracostomy. The 1-year and 3-year mortality rates were 25.0% and 40.0% respectively, compared to 14.6% 1-year and 21.6% 3-year mortality rates in overall population of OLT recipients at our institution. In comparison to the overall population of OLT recipients, whose average postoperative length of stay was 34 days, our cohort spent an average of 73 days in the hospital after OLT on the index admission, and had an average of 1.45 readmissions within the first calendar year post OLT.
CONCLUSIONS: Patients with TL prior to OLT have increased 1-year and 3-year mortality and health care utilization. Nevertheless, the actual clinical significance and recognition of other concomitant factors that predict poorer outcomes in this population are still largely missing. Further investigation should be focused on this population, with the goal of improving postoperative liver transplantation outcomes and survival.
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