Respiratory System Compliance Predicts Outcome After Lung Transplantation-A Retrospective Single Center Study

Background: Outcome prediction in patients undergoing lung transplantation (LUTX) for end-stage pulmonary disease can be challenging. We examined the prognostic value for mortality of respiratory system compliance (C_RS) and mechanical power of ventilation (MP) at end of surgery in patients undergoing LUTX for end-stage pulmonary disease. Methods: In this single-center retrospective study, we included 755 patients undergoing LUTX between 2014 and 2023. The primary endpoint of this study was 1-year mortality, with 30-day mortality serving as a secondary endpoint. We conducted both univariate and multivariate analyses and constructed Receiver Operating Characteristic curves. Results: Of 755 patients, 1.9% and 12.2% patients died within 30 days and 1 year after LUTX. Fifteen-point four percent of all patients required extracorporeal membrane oxygenation (ECMO) prolongation into the early postoperative period. C_RS, but not MP was higher in 1-year survivors compared to non-survivors [median 25.8 mL/cmH₂O (20.1, 32.1) and 22.5 mL/cmH₂O (15.2, 28.4); p < 0.001] and [median 10.0 J/min (7.8, 12.0) and 9.3 J/min (6.2, 13.1); p = 0.329]. Moreover, low C_RS < 25.1 mL/cmH₂O remained an independent factor for increased 1-year mortality after LUTX. Additionally, increased MP and C_RS were predictive for 30-day survival with an acceptable area under the curve of 0.758 (95% CI: 0.6-0.8; p < 0.001) and 0.735 (95% CI: 0.5-0.9; p = 0.003), and a sensitivity and specificity of 51% and 75.5% for MP and 50% and 85% for C_RS, respectively. Conclusions: Postoperative C_RS serves as a significant independent predictor for short and long-term outcome in patients undergoing LUTX with and without ECMO prolongation into the early postoperative period.