Prolonged mechanical ventilation after lung transplant: predictors and impact on survival

Background: Following lung transplantation (LTx), some recipients require prolonged mechanical ventilation (PMV), which can impact the benefit of LTx. Therefore, we sought to determine the risk factors for PMV and impact on survival in a single transplant center retrospective study. Methods: From 1/2008 to 1/2019, 1,140 LTx were performed at Cleveland Clinic, Ohio. Mean age was 57 +/- 13 years-old, 33% were females, and 59% had restrictive lung disease. We divided the cohort into subgroups based on duration of MV (<= 2, 3-21, 22-90, >90 days). Univariate and logistic regression analysis of baseline characteristics and peri-operative variables were utilized to identify risk factors for PMV >21 days and mortality. Results: Recipients underwent PMV >21 days (21%) had higher lung allocation scores, bridging on MV or extracorporeal membrane oxygenation (ECMO), longer cardiopulmonary bypass, re-exploration for bleeding, higher grades of primary graft dysfunction (PGD), and post-LTx dialysis (P<0.0001). PMV >21 days was significantly associated with in-hospital mortality and worse survival (P<0.0001). Predictors of PMV >21 days were bridging on ECMO, dialysis, PGD, re-exploration for bleeding, and airway complications. PMV >21 days and single LTx were independent risk factors for worse survival after LTx. Conclusions: Efforts directed at minimizing PMV could be focused recipient selection and perioperative factors that influence PMV to optimize utilization of available organs.