Post-Transplant Pulmonary Embolism Is Associated With Allograft Dysfunction and Worse Survival

SESSION TITLE: Preconditions and Outcomes in Lung Transplantation SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Pulmonary embolism (PE) is an infrequent but important complication after lung transplantation. This analysis sought to describe the incidence of PE in lung transplant recipients (LTR) and associations with subsequent airway stenosis, time to chronic lung allograft dysfunction (CLAD) and survival. METHODS: This was a single center retrospective analysis of first lung transplant recipients since May 2005. PE was considered as a time dependent variable in CLAD, stenosis and survival models as well as an early event (within 180 days of transplant) and within a year as a time independent event in survival models. RESULTS: 908 LTR were eligible for inclusion with 56 (6%) LTR having at least one PE event during the follow up period (905 days median). Of the 695 LTR with sufficient data to assess for CLAD, PE was strongly associated with the subsequent risk of CLAD (HR 2.509, p <0.001). In the entire cohort of 908 LTR, a PE event was also strongly associated with the development of airways stenosis (p<0.0001). PE was considered in time independent survival models at 180 days and 1 year. A PE in the first 180 days was strongly associated with death (HR 5.0082, p = 0.03). However, a PE within one year after transplant was not associated with an increased risk of death. When PE was considered as a time dependent variable considering all available follow up, PE was strongly associated with worse survival (HR 2.548, p <0.001). CONCLUSIONS: PE after transplant is associated with subsequent airway stenosis and with CLAD. In addition, PE is a strong risk factor for worse survival, particularly if it occurs in the first 180 days after transplant. CLINICAL IMPLICATIONS: LTR who develop a PE in the first 180 days after transplant are at a significantly higher risk of death. LTR that have a PE and survive have a significantly higher risk of developing airway stenosis and CLAD. The diagnosis of PE in LTRs should alert clinicians to a higher risk of CLAD and death. DISCLOSURE: The following authors have nothing to disclose: Michael Dorry, Scott Shofer, Kamran Mahmood, Kristen Glisinski, Laurie Snyder No Product/Research Disclosure Information