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Digital Gangrene and Postoperative Survival Following Lung or Heart-Lung Transplantation in Patients With Systemic
Brian S Lee1, Jason H Melehani1,2, Shufeng Li3,4
1Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California.
Objective:
Digital gangrene is a severe complication of systemic sclerosis (SSc). This study aimed to examine the incidence and clinical associations of digital gangrene in patients with SSc after lung or heart-lung transplantation.
Methods:
We performed a retrospective study of patients with SSc (SSc group) who underwent lung or heart-lung transplant surgery from 2001 to 2021. The SSc group was compared with patients with other autoimmune diseases (autoimmune group) and patients without autoimmune diseases (control group) who underwent lung or heart-lung transplant.
Results:
A total of 212 patients were included in this study: 16, 55, and 141 patients in SSc, autoimmune, and control groups, respectively. Four patients (25%) in the SSc group and none from the other groups developed dry digital gangrene during the index hospitalization (P < 0.0001). The median time to digital gangrene onset was 44.5 (range 8-90) days postoperatively. All patients with SSc with digital gangrene had diabetes, whereas only four patients with SSc (33.3%) without digital gangrene had diabetes. Patients with SSc with digital gangrene had a longer median duration of postoperative vasoconstrictor therapy (15.5 days) compared with patients with SSc without digital gangrene (3.0 days). The median survival time was significantly shorter for patients with SSc with digital gangrene (0.9 years) than for all patients without (7.6 years; P < 0.0003).
Conclusion:
Patients with SSc are uniquely at risk for digital gangrene following lung or heart-lung transplant, with an incidence rate of 25%. Diabetes and prolonged postoperative vasoconstrictor therapy may contribute to its development. Digital gangrene is associated with lower survival, highlighting the importance of further research.
