C47-06 Early Mortality After Lung Transplantation: A Single Center Retrospective Analysis of Deaths Within the First Year Post-Transplant

Abstract Rationale Mortality within one year following lung transplantation is well described in the literature. A descriptive analysis of the morbidity endured by patients who suffer a one-year mortality serves to aid shared decision-making for patients considering lung transplantation. Methods We conducted a retrospective review of lung transplant recipients at the University of Utah from 1987-2024 who died within one year of transplant. Sixty-three charts were reviewed independently by two reviewers. 31 patients were included, with exclusions due to incomplete records. Demographic, clinical, and outcome data were collected and analyzed descriptively. Results The median age was 66 years (range 24-71). 12 patients (39%) had prior intrathoracic interventions. 5 patients (16%) were hospitalized prior to transplant, 1 on extracorporeal-membrane-oxygenation (ECMO), 3 on mechanical ventilation, and 1 on high flow nasal cannula. Transplant types included 22 bilateral, 9 single, with one redo single-lung transplant. 14 were performed with cardiopulmonary bypass (CPB), 8 with ECMO, and 2 had unanticipated conversions to CPB. Median bypass/ECMO run time was 204 minutes. Median index hospitalization lasted 42 days, with a median ICU stay of 27 days. Thirteen patients (42%) were discharged home, 13 (42%) to rehabilitation (3 readmitted), and 5 (16%) died during index hospitalization. Post-transplant complications included: vocal cord paralysis (3.2%), stroke (9.7%), delayed graft function (9.7%), vascular reintervention (9.7%), bronchial anastomosis reintervention (12.9%), rejection (16.1%), cardiac arrest (32.3%), pleural effusion requiring drainage (45.2%), infection (41.9%), arrhythmia (48.4%), transfusion (51.6%), postoperative renal replacement therapy (58.1%, mean duration of renal replacement therapy 45.8 days), tracheostomy (61.3%), and postoperative ECMO (38.7%, mean duration 21 days). Mean total ICU stay was 38.9 days (median 35.5), hospital stay 61.1 days (median 48), and total inpatient + rehab duration 74.8 days (median 68.5). Mean time from transplant to death was 123 days (median 100); 16 patients survived 100 days. Most deaths occurred in the ICU (54.8%), followed by the hospital floor (19.4%), home (16.1%), and inpatient hospice (3.2%). Five patients died on ECMO and 18 on mechanical ventilation. Conclusions In this single-center cohort of lung transplant recipients who died within one year of transplantation, most were older with multiple comorbidities. Prolonged ICU and hospital stay, respiratory failure requiring mechanical ventilation and tracheostomy, as well as renal failure characterized this population. This provides a descriptive analysis of morbidities endured by patients who suffer a 1-year mortality, which may aid patient counselling when choosing therapies for end-stage lung disease. This abstract is funded by: None