Monday, August 11, 2008

Prognosis in lung transplant patients with chronic rejection

The American Journal of Critical Care has a study about the natural history of chronic rejection after lung transplantation, which they state is the primary cause of death in lung transplant patients after the 1st year post-transplant. This study is a single-institution case series which presents the natural history of the 60 patients (out of 300 total transplants) who developed chronic rejection over an 8 year period. 26 patients died during the time of data collection. Median survival or time to re-transplant was 31 months after the onset of chronic rejection. Yes that's not a particularly helpful figure, but given the reality that some of these patients can be 'saved' with re-transplantation, and thus the natural history of chronic rejection depends heavily on the availability and success of re-transplantion, that's the best info we have....

They had only sparse data on the circumstances of death for the patients who died: it appears most of them died in the ICU, and they note that end-of-life discussions were initiated by family members most of the time (at least for those patients on whom they had data). Overall a picture is painted of a very sick population who spend a tremendous amount of time in the hospital, and receive very intensive care right up to the point of death.

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