BACKGROUND: Lung retransplantation became an accepted treatment for bronchiolitis obliterans syndrome (BOS). However, the value of different bridging modalities for these patients is controversial. METHODS: We analyzed outcomes of 39 patients listed for retransplantation between 2008 and 2012. Patients were divided in 3 groups: 23 patients without any bridge modality (elective, Group 1), 11 patients on ventilation and full sedation with or without extracorporeal membrane oxygenation (ECMO) support (sedated bridging, Group 2), and 5 patients awake on ECMO support (awake bridging, Group 3). RESULTS: Waiting list mortality was 13% in Group 1, 39% in Group 2, and 0% in Group 3. Perioperative mortality was 20% in Group 1, 29% in Group 2, and 0% in Group 3. Significant differences between Groups 1 and 2 were calculated for time on post-operative ventilation (17.4 vs 27.3 days, p = 0.022), intensive care unit stay (22.0 vs 32.9 days, p = 0.026), and hospital stay (34.7 vs 54.1 days, p = 0.013). However, there were no significant differences between Groups 1 and 3 for post-operative ventilation time (17.4 vs 13.4 days, p = 0.192), for intensive care unit stay (22.0 vs 26.4 days, p = 0.169), or for hospital stay (34.7 vs 34.8 days, p = 0.367). Survival rates at 90 days, 1 year, and 2 years were 80%, 70%, and 53% in Group 1; 71%, 43%, and 29% in Group 2; and 100%, 60%, and 60% in Group 3, respectively. CONCLUSION: Awake ECMO bridging for retransplantation provides comparable results to elective retransplantation.
BACKGROUND: Lung retransplantation became an accepted treatment for bronchiolitis obliterans syndrome (BOS). However, the value of different bridging modalities for these patients is controversial. METHODS: We analyzed outcomes of 39 patients listed for retransplantation between 2008 and 2012. Patients were divided in 3 groups: 23 patients without any bridge modality (elective, Group 1), 11 patients on ventilation and full sedation with or without extracorporeal membrane oxygenation (ECMO) support (sedated bridging, Group 2), and 5 patients awake on ECMO support (awake bridging, Group 3). RESULTS: Waiting list mortality was 13% in Group 1, 39% in Group 2, and 0% in Group 3. Perioperative mortality was 20% in Group 1, 29% in Group 2, and 0% in Group 3. Significant differences between Groups 1 and 2 were calculated for time on post-operative ventilation (17.4 vs 27.3 days, p = 0.022), intensive care unit stay (22.0 vs 32.9 days, p = 0.026), and hospital stay (34.7 vs 54.1 days, p = 0.013). However, there were no significant differences between Groups 1 and 3 for post-operative ventilation time (17.4 vs 13.4 days, p = 0.192), for intensive care unit stay (22.0 vs 26.4 days, p = 0.169), or for hospital stay (34.7 vs 34.8 days, p = 0.367). Survival rates at 90 days, 1 year, and 2 years were 80%, 70%, and 53% in Group 1; 71%, 43%, and 29% in Group 2; and 100%, 60%, and 60% in Group 3, respectively. CONCLUSION: Awake ECMO bridging for retransplantation provides comparable results to elective retransplantation.
Authors: Antoine Legras; Pierre Mordant; Nicolas Brechot; Alain Bel; Véronique Boussaud; Romain Guillemain; Bernard Cholley; Laure Gibault; Françoise Le Pimpec-Barthes; Alain Combes Journal: Intensive Care Med Date: 2015-07-16 Impact factor: 17.440
Authors: Marius M Hoeper; Raymond L Benza; Paul Corris; Marc de Perrot; Elie Fadel; Anne M Keogh; Christian Kühn; Laurent Savale; Walter Klepetko Journal: Eur Respir J Date: 2019-01-24 Impact factor: 16.671