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Volume 14
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10.3390/jcm14196941
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

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

by
Cecilia Veraar
1,*,
Stefan Schwarz
2,
Peter Wohlrab
1,
Johannes Geilen
1,
Arabella Fischer
1,
Thomas Neugebauer
1,
Caroline Hillebrand
2,
Bernhard Moser
2,
Konrad Hoetzenecker
2,
Martin Dworschak
1,
Marcus J. Schultz
1,3 and
Edda M. Tschernko
1
1
Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
2
Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
3
Department of Intensive Care Medicine, Amsterdam University Medical Center, 1007 MB Amsterdam, The Netherlands
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(19), 6941; https://doi.org/10.3390/jcm14196941
Submission received: 21 July 2025 / Revised: 21 August 2025 / Accepted: 26 September 2025 / Published: 30 September 2025
(This article belongs to the Special Issue Cardiothoracic and Vascular Anesthesia—Clinical Management and Challenges)
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Abstract

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 (CRS) 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. CRS, 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 CRS < 25.1 mL/cmH2O remained an independent factor for increased 1–year mortality after LUTX. Additionally, increased MP and CRS 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 CRS, respectively. Conclusions: Postoperative CRS 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.
Keywords: lung transplantation; respiratory system compliance; outcome; mechanical power lung transplantation; respiratory system compliance; outcome; mechanical power
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MDPI and ACS Style

Veraar, C.; Schwarz, S.; Wohlrab, P.; Geilen, J.; Fischer, A.; Neugebauer, T.; Hillebrand, C.; Moser, B.; Hoetzenecker, K.; Dworschak, M.; et al. Respiratory System Compliance Predicts Outcome After Lung Transplantation—A Retrospective Single Center Study. J. Clin. Med. 2025, 14, 6941. https://doi.org/10.3390/jcm14196941

AMA Style

Veraar C, Schwarz S, Wohlrab P, Geilen J, Fischer A, Neugebauer T, Hillebrand C, Moser B, Hoetzenecker K, Dworschak M, et al. Respiratory System Compliance Predicts Outcome After Lung Transplantation—A Retrospective Single Center Study. Journal of Clinical Medicine. 2025; 14(19):6941. https://doi.org/10.3390/jcm14196941

Chicago/Turabian Style

Veraar, Cecilia, Stefan Schwarz, Peter Wohlrab, Johannes Geilen, Arabella Fischer, Thomas Neugebauer, Caroline Hillebrand, Bernhard Moser, Konrad Hoetzenecker, Martin Dworschak, and et al. 2025. "Respiratory System Compliance Predicts Outcome After Lung Transplantation—A Retrospective Single Center Study" Journal of Clinical Medicine 14, no. 19: 6941. https://doi.org/10.3390/jcm14196941

APA Style

Veraar, C., Schwarz, S., Wohlrab, P., Geilen, J., Fischer, A., Neugebauer, T., Hillebrand, C., Moser, B., Hoetzenecker, K., Dworschak, M., Schultz, M. J., & Tschernko, E. M. (2025). Respiratory System Compliance Predicts Outcome After Lung Transplantation—A Retrospective Single Center Study. Journal of Clinical Medicine, 14(19), 6941. https://doi.org/10.3390/jcm14196941

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