Cause of Death after Lung Transplantation - A Single Center Analysis

Purpose Postoperative cause of death in lung transplantation and time to its occurrence is reported occasionally. This study investigated all causes of death in our lung transplant recipients. Methods All recipients transplanted between 1992 and 2018 were included. Follow-up date was October 2019. Median (min-max) survival was calculated to compare tendencies of incidence between groups. Results Among all 521 transplantations performed, 333 recipients (63.9%) died. Median time from transplantation to death was 40 (0-278) months. Deaths which occurred within 1 month after transplantation were predominantly due to primary graft dysfunction (N=15, 4.5%), followed by cytomegalovirus infection (N=9, 2.7%), major bleeding (N=6, 1.8%) and idiopathic hyperammonemia (N=4, 1.2%). Among all non-cytomegalovirus-infections (N=63, 19.9%), pneumonia (N=36, 10.8%) was the major cause of death, followed by colon perforation (N=12, 3.6%) and cholangitis (N=4, 1.2%). Observation time was median 21(0-230), 11.5(1-278) and 55(28-122) months, respectively. Among patients with malignomas, death due to lymphoma (N=10, 3.0%) occurred after a median of 29.5(12-67) months, death due to carcinoma (N=36, 10.8%) after 92(19-219) months. Cerebrovascular insult/bleeding led to 13 deaths (3.9%) after a median of 9(0-181) months. Death due to acute rejection (N=4, 1.2%) was observed at a median of 9(0-45) months. Chronic lung allograft dysfunction (CLAD) was diagnosed in 129 cases (38.7%), being the largest group with CLAD only as cause of death in 77 patients at a median onset of 53(5-246) months; CLAD and additional infection (N=44, 13.2%) median onset 39(5-145) months; CLAD and additional multi organ dysfunction (N=8, 2.4%) median onset 78(18-198) months. Cardiac (N=19, 5.7%) and renal failures (N=5, 1.5%) occurred late: median 103(0-271) months and 84(17-150) months, respectively. Conclusion There is a large variety of causes of death after lung transplantation with a dominant role of infection, CLAD and carcinoma. With increasing follow-up time, infection becomes less prevalent and CLAD and carcinoma are observed more frequently.