Annals of internal medicine · 2000
Fatal hyperammonemia after orthotopic lung transplantation.
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Lichtenstein G R, Yang Y X, Nunes F A, Lewis J D, Tuchman M, Tino G, Kaiser L R, Palevsky H I, Kotloff R M, Furth E E, Bavaria J E, Stecker M M, Kaplan P, Berry G T
Аннотация
BACKGROUND: A case of fatal hyperammonemia complicating orthotopic lung transplantation was previously reported.
OBJECTIVE: To describe the incidence, clinical features, and treatment of hyperammonemia associated with orthotopic lung transplantation.
DESIGN: Retrospective cohort analysis.
SETTING: Academic medical center and lung transplantation center in Philadelphia, Pennsylvania.
PATIENTS: 145 sequential adult patients who underwent orthotopic lung transplantation.
MEASUREMENTS: Plasma ammonium levels.
RESULTS: Six of the 145 patients who had had orthotopic lung transplantation developed hyperammonemia, all within the first 26 days after transplantation. The 30-day post-transplantation mortality rate was 67% for patients with hyperammonemia compared with 17% for those without hyperammonemia (P = 0.01). Development of major gastrointestinal complications (P = 0.03), use of total parenteral nutrition (P < 0.001), and lung transplantation for primary pulmonary hypertension (P = 0.045) were associated with hyperammonemia.
CONCLUSIONS: Hyperammonemia is a potentially fatal event occurring after orthotopic lung transplantation. It is associated with high nitrogen load, concurrent medical stressors, primary pulmonary hypertension, and hepatic glutamine synthetase deficiency.
OBJECTIVE: To describe the incidence, clinical features, and treatment of hyperammonemia associated with orthotopic lung transplantation.
DESIGN: Retrospective cohort analysis.
SETTING: Academic medical center and lung transplantation center in Philadelphia, Pennsylvania.
PATIENTS: 145 sequential adult patients who underwent orthotopic lung transplantation.
MEASUREMENTS: Plasma ammonium levels.
RESULTS: Six of the 145 patients who had had orthotopic lung transplantation developed hyperammonemia, all within the first 26 days after transplantation. The 30-day post-transplantation mortality rate was 67% for patients with hyperammonemia compared with 17% for those without hyperammonemia (P = 0.01). Development of major gastrointestinal complications (P = 0.03), use of total parenteral nutrition (P < 0.001), and lung transplantation for primary pulmonary hypertension (P = 0.045) were associated with hyperammonemia.
CONCLUSIONS: Hyperammonemia is a potentially fatal event occurring after orthotopic lung transplantation. It is associated with high nitrogen load, concurrent medical stressors, primary pulmonary hypertension, and hepatic glutamine synthetase deficiency.