초록접수 현황
| 20F-190 | 구연 발표 |
Risk factor analysis for hyperammonemia in lung transplantation
Ha Eun Kim, Young Ho Yang, Byung Jo Park, Seong Yong Park, Chang Young Lee, Jin Gu Lee, Dae Joon Kim, Jin Gu Lee, Hyo Chae Paik
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
Purpose : Idiopathic hyperammonemia syndrome (IHS) is a rare, often fatal complication of lung transplantation. Multiple treatments have been documented including dialysis, nitrogen scavengers, and bowel decontaminations, however, no definite treatments exist so far and mortality remains high. Recent report revealed few causatives for hyperammonemia such as a mollicute, Ureaplasma, however, the etiology is still not clearly described.
Methods : 283 patients underwent lung transplantation from January 2013 to June 2020 were retrospectively reviewed. We defined hyperammonemia as serum ammonia >56 ug/dl and severe hyperammonemia as >128ug/dl, and IHS as >1000ug/dl on at least 1 occasion.
Results : Elevated ammonia level was detected in 134patients (47%) on median postoperative 10.4days. 38patients (13.4%) developed severe hyperammonemia and 4patients (1.4%) suffered IHS. Mean peak ammonia level was 149.5ug/dl in patients with elevated ammonia level and 296.4ug/dl in severe hyperammonemia patients. The peak level was detected on median postoperative 22.5days. 21 of 34patients with severe hyperammonemia were treated with renal replacement therapy, and 29 of 34patients were treated with lactulose bowel decontamination. Hyperammonemia was resolved in 28 of 34patients. Logistic regression analysis demonstrated that underlying chronic renal disease (OR 5.9, p=0.003), pretransplant hospital stay (OR 3.0, p=0.037), total operation time (OR1.1, p=0.003), postoperative extracorporeal oxygenation support (OR1.1, p=0.002), acute rejection (OR 7.4, p=0.014), as significant risk factors for developing severe hyperammonemia.
Conclusion : The incidence of IHS was only 1.4% but fatal, thus it is important to be aware of predisposing status. Identifying high risk patients and applying aggressive treatment strategy might helpful to break through the lethal IHS.
Methods : 283 patients underwent lung transplantation from January 2013 to June 2020 were retrospectively reviewed. We defined hyperammonemia as serum ammonia >56 ug/dl and severe hyperammonemia as >128ug/dl, and IHS as >1000ug/dl on at least 1 occasion.
Results : Elevated ammonia level was detected in 134patients (47%) on median postoperative 10.4days. 38patients (13.4%) developed severe hyperammonemia and 4patients (1.4%) suffered IHS. Mean peak ammonia level was 149.5ug/dl in patients with elevated ammonia level and 296.4ug/dl in severe hyperammonemia patients. The peak level was detected on median postoperative 22.5days. 21 of 34patients with severe hyperammonemia were treated with renal replacement therapy, and 29 of 34patients were treated with lactulose bowel decontamination. Hyperammonemia was resolved in 28 of 34patients. Logistic regression analysis demonstrated that underlying chronic renal disease (OR 5.9, p=0.003), pretransplant hospital stay (OR 3.0, p=0.037), total operation time (OR1.1, p=0.003), postoperative extracorporeal oxygenation support (OR1.1, p=0.002), acute rejection (OR 7.4, p=0.014), as significant risk factors for developing severe hyperammonemia.
Conclusion : The incidence of IHS was only 1.4% but fatal, thus it is important to be aware of predisposing status. Identifying high risk patients and applying aggressive treatment strategy might helpful to break through the lethal IHS.
책임저자: Hyo Chae Paik
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
발표자: Ha Eun Kim , E-mail : gracehn@yuhs.ac