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American Journal of Critical Care. 2008;17: 246-253
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Course of Illness after the Onset of Chronic Rejection in Lung Transplant Recipients

By Mi-Kyung Song, RN, PhD, Annette De Vito Dabbs, RN, PhD, Sean M. Studer, MD and Sarah E. Zangle, RN, BSN. Mi-Kyung Song is an assistant professor in the School of Nursing at the University of North Carolina, Chapel Hill. Annette De Vito Dabbs is an assistant professor in the Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania. Sean M. Studer is an assistant professor in the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, and Sarah E. Zangle is staff nurse in the emergency department, Children’s Hospital of the University of Pittsburgh Medical Center.

Corresponding author: Mi-Kyung Song, PhD, Assistant Professor, School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, CB#7460, Chapel Hill, NC 27599-7460 (e-mail: songm{at}email.unc.edu).

Background Despite the overall negative impact of chronic rejection on quality of life and survival after lung transplant, the specific clinical indicators of deterioration have not been identified.

Objectives To describe the course of illness after the onset of chronic rejection, including demographic and transplant variables, morbidity, mortality, health resource utilization, and end-of-life care, and to identify clinical indicators of deterioration in health and limited survival after the onset of chronic rejection.

Methods The medical records of 311 recipients of lung transplants between 1998 and 2004 were reviewed retrospectively to identify 60 recipients who experienced chronic rejection.

Results Median survival after chronic rejection was 31.34 months. Time to rejection (mean, 26.05 months; SD, 16.85) was significantly correlated with overall survival without need of a retransplant (r = 0.64; P < .001). The earlier the onset of chronic rejection or the need for oxygen at home, the shorter was the period of survival after chronic rejection and the more frequent were hospital and intensive care unit admissions and prolonged stays. Of the 26 recipients who died, 65% died at the transplant center, and all but 1 died in the intensive care unit; 3 died after multiple attempts of cardiopulmonary resuscitation; life support was ultimately withdrawn in 69%.

Conclusions Lung transplant recipients who experience chronic graft rejection have high rates of morbidity, mortality, and health resource utilization; however, the course of illness after chronic rejection is highly variable.






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