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15 February 2000 | Volume 132 Issue 4 | Pages 283-287
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.
Author and Article Information
From the Hospital of the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Washington Children's Hospital, Washington, D.C.
Acknowledgments: The authors thank Anil K. Rustgi, MD, of the Hospital of the University of Pennsylvania for thoughtful review of the manuscript and Nancy D. Bridges, MD, and Thomas L. Spray, MD, of The Children's Hospital of Philadelphia for their contributions to this study.
Requests for Single Reprints: Gary R. Lichtenstein, MD, Gastroenterology Division, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, 3 Ravdin Building, 3400 Spruce Street, Philadelphia, PA 19104-4283.
Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
Current Author Addresses: Drs. Lichtenstein, Yang, Nunes, and Lewis: Gastroenterology Division, Department of Medicine, Hospital of the University of Pennsylvania, 3 Ravdin Building, 3400 Spruce Street, Philadelphia, PA 19104-4283.
Dr. Tuchman: Research Department, Washington Children's Hospital, 111 Michigan Avenue NW, Washington, DC 20010.
Drs. Tino, Palevsky, and Kotloff: Pulmonary and Critical Care Division, Department of Medicine, Hospital of the University of Pennsylvania, 3 Gates Building, 3400 Spruce Street, Philadelphia, PA 19104-4283.
Drs. Kaiser and Bavaria: Department of Surgery, Hospital of the University of Pennsylvania, 6 Silverstein Building, 3400 Spruce Street, Philadelphia, PA 19104-4283.
Dr. Furth: Department of Pathology, Hospital of the University of Pennsylvania, 6 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104-4283.
Dr. Stecker: Department of Neurology, Hospital of the University of Pennsylvania, 4 Silverstein Building, 3400 Spruce Street, Philadelphia, PA 19104-4283.
Drs. Kaplan and Berry: Department of Pediatrics, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104.
Author Contributions: Conception and design: G.R. Lichtenstein, Y.-X. Yang, F. Nunes, J.D. Lewis, M. Tuchman, G. Tino, L.R. Kaiser, H. Palevsky, R.M. Kotloff, E.E. Furth, J.E. Bavaria, M.M. Stecker, G.T. Berry.
Analysis and interpretation of the data: G.R. Lichtenstein, Y.-X. Yang, F. Nunes, J.D. Lewis, M. Tuchman, G. Tino, L.R. Kaiser, H. Palevsky, R.M. Kotloff, E.E. Furth, J.E. Bavaria, M.M. Stecker, P. Kaplan, G.T. Berry.
Drafting of the article: G.R. Lichtenstein, Y.-X. Yang, F. Nunes, J.D. Lewis, M. Tuchman, G. Tino, H. Palevsky, R.M. Kotloff, M.M. Stecker, P. Kaplan, G.T. Berry.
Critical revision of the article for important intellectual content: G.R. Lichtenstein, Y.-X. Yang, F. Nunes, J.D. Lewis, M. Tuchman, G. Tino, L.R. Kaiser, H. Palevsky, R.M. Kotloff, E.E. Furth, J.E. Bavaria, M.M. Stecker, P. Kaplan, G.T. Berry.
Final approval of the article: G.R. Lichtenstein, Y.-X. Yang, F. Nunes, J.D. Lewis, M. Tuchman, G. Tino, L.R. Kaiser, H. Palevsky, R.M. Kotloff, E.E. Furth, J.E. Bavaria, M.M. Stecker, P. Kaplan, G.T. Berry.
Provision of study materials or patients: G.R. Lichtenstein, Y.-X. Yang, G. Tino, L.R. Kaiser, H. Palevsky, R.M. Kotloff, E.E. Furth, J.E. Bavaria, P. Kaplan, G.T. Berry.
Statistical expertise: G.R. Lichtenstein, Y.-X. Yang, J.D. Lewis.
Administrative, technical, or logistic support: G.R. Lichtenstein, Y.-X. Yang.
Collection and assembly of data: G.R. Lichtenstein, Y.-X. Yang, M. Tuchman, L.R. Kaiser, H. Palevsky, J.E. Bavaria, P. Kaplan. BRIEF COMMUNICATION
Fatal Hyperammonemia after Orthotopic Lung Transplantation
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