Massimo Boffini1, Erika Simonato1, Davide Ricci1, Fabrizio Scalini1, Matteo Marro1, Stefano Pidello1, Matteo Attisani1, Paolo Solidoro2, Paolo Olivo Lausi3, Vito Fanelli4, Cristina Barbero1, Luca Brazzi4, Mauro Rinaldi1. 1. Cardiac Surgery Division, Surgical Sciences Department, Città della Salute e della Scienza, University of Torino, Turin, Italy. 2. Pulmonology Division, Medical Sciences Department, Città della Salute e della Scienza, University of Torino, Turin, Italy. 3. Thoracic Surgery Division, Surgical Sciences Department, Città della Salute e della Scienza, University of Torino, Turin, Italy. 4. Anesthesiology and Intensive Care Division, Surgical Sciences Department, Città della Salute e della Scienza, University of Torino, Turin, Italy.
Abstract
BACKGROUND: Lung transplantation is the treatment of choice for end-stage pulmonary disease in selected patients. However, severe primary graft dysfunction is a significant complication of transplant and requires the implantation of an extracorporeal support. The aim of the study is to evaluate the impact of extracorporeal membrane oxygenation (ECMO) after transplant in our center. METHODS: From January 2008 till June 2018, 195 consecutive unselected patients receiving a lung transplant were considered. Mean age was 49±15 years. Main indications for transplant were idiopathic pulmonary fibrosis in 72 patients, chronic obstructive pulmonary disease in 60 patients, and cystic fibrosis in 40 patients. Prior to transplant, 18 patients were on mechanical ventilation and 14 were on ECMO. RESULTS: Twenty-five patients required venous-venous ECMO after transplant. Vascular disease as cause of transplant [relative risk (RR) 7.8, 95% CI: 1.5-41, P=0.02], donor age (RR 1.6, 95% CI: 1.03-2.3, P=0.03) and need for cardiopulmonary by-pass during transplant (RR 3.1, 95% CI: 1.02-9, P=0.04) were associated with ECMO implantation. Patients requiring post-transplant ECMO received more transfusions (P<0.01), had a longer mechanical ventilation (P<0.01) and ICU stay (P<0.01) and had a higher hospital mortality (P<0.01). Post-transplant ECMO significantly influenced one- and five-year survival [hazard ratio (HR) 5.5, 95% CI: 3-10, P<0.001 and HR 3.5, 95% CI: 2-6, P<0.001, respectively]. However, conditional survival after t months is similar for patients with or without post-transplant ECMO. CONCLUSIONS: In our experience, although ECMO is a reliable and effective strategy to support pulmonary function, severe graft dysfunction after lung transplantation still has a significant impact on early and late results.
BACKGROUND: Lung transplantation is the treatment of choice for end-stage pulmonary disease in selected patients. However, severe primary graft dysfunction is a significant complication of transplant and requires the implantation of an extracorporeal support. The aim of the study is to evaluate the impact of extracorporeal membrane oxygenation (ECMO) after transplant in our center. METHODS: From January 2008 till June 2018, 195 consecutive unselected patients receiving a lung transplant were considered. Mean age was 49±15 years. Main indications for transplant were idiopathic pulmonary fibrosis in 72 patients, chronic obstructive pulmonary disease in 60 patients, and cystic fibrosis in 40 patients. Prior to transplant, 18 patients were on mechanical ventilation and 14 were on ECMO. RESULTS: Twenty-five patients required venous-venous ECMO after transplant. Vascular disease as cause of transplant [relative risk (RR) 7.8, 95% CI: 1.5-41, P=0.02], donor age (RR 1.6, 95% CI: 1.03-2.3, P=0.03) and need for cardiopulmonary by-pass during transplant (RR 3.1, 95% CI: 1.02-9, P=0.04) were associated with ECMO implantation. Patients requiring post-transplant ECMO received more transfusions (P<0.01), had a longer mechanical ventilation (P<0.01) and ICU stay (P<0.01) and had a higher hospital mortality (P<0.01). Post-transplant ECMO significantly influenced one- and five-year survival [hazard ratio (HR) 5.5, 95% CI: 3-10, P<0.001 and HR 3.5, 95% CI: 2-6, P<0.001, respectively]. However, conditional survival after t months is similar for patients with or without post-transplant ECMO. CONCLUSIONS: In our experience, although ECMO is a reliable and effective strategy to support pulmonary function, severe graft dysfunction after lung transplantation still has a significant impact on early and late results.
Authors: Daniel C Chambers; Roger D Yusen; Wida S Cherikh; Samuel B Goldfarb; Anna Y Kucheryavaya; Kiran Khusch; Bronwyn J Levvey; Lars H Lund; Bruno Meiser; Joseph W Rossano; Josef Stehlik Journal: J Heart Lung Transplant Date: 2017-07-19 Impact factor: 10.247
Authors: Dirk Van Raemdonck; Matthew G Hartwig; Marshall I Hertz; R Duane Davis; Marcelo Cypel; Don Hayes; Steve Ivulich; Jasleen Kukreja; Erika D Lease; Gabriel Loor; Olaf Mercier; Luca Paoletti; Jasvir Parmar; Reinaldo Rampolla; Keith Wille; Rajat Walia; Shaf Keshavjee Journal: J Heart Lung Transplant Date: 2017-07-21 Impact factor: 10.247
Authors: Igor Tudorache; Wiebke Sommer; Christian Kühn; Olaf Wiesner; Johannes Hadem; Thomas Fühner; Fabio Ius; Murat Avsar; Nicolaus Schwerk; Dietmar Böthig; Jens Gottlieb; Tobias Welte; Christoph Bara; Axel Haverich; Marius M Hoeper; Gregor Warnecke Journal: Transplantation Date: 2015-02 Impact factor: 4.939
Authors: Marcelo Cypel; Bronwyn Levvey; Dirk Van Raemdonck; Michiel Erasmus; John Dark; Robert Love; David Mason; Allan R Glanville; Daniel Chambers; Leah B Edwards; Josef Stehlik; Marshall Hertz; Brian A Whitson; Roger D Yusen; Varun Puri; Peter Hopkins; Greg Snell; Shaf Keshavjee Journal: J Heart Lung Transplant Date: 2015-09-03 Impact factor: 10.247
Authors: M Boffini; D Ricci; C Barbero; R Bonato; M Ribezzo; E Mancuso; M Attisani; E Simonato; P Magistroni; M Mansouri; P Solidoro; S Baldi; D Pasero; A Amoroso; M Rinaldi Journal: Transplant Proc Date: 2013-09 Impact factor: 1.066