Fabio Ius1, Khalil Aburahma2, Dietmar Boethig2, Jawad Salman2, Wiebke Sommer3, Helge Draeger2, Reza Poyanmehr2, Murat Avsar2, Thierry Siemeni2, Dmitry Bobylev2, Joerg Optenhoefel2, Olaf Wiesner4, Mark Greer4, Nicolaus Schwerk5, Marius M Hoeper6, Tobias Welte6, Axel Haverich3, Christian Kuehn2, Gregor Warnecke3, Jens Gottlieb6, Igor Tudorache2. 1. Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany. Electronic address: ius.fabio@mh-hannover.de. 2. Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany. 3. Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany. 4. Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany. 5. Department of Paediatrics, Hannover Medical School, Hannover, Germany. 6. Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany; Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
Abstract
INTRODUCTION: Over the past decade, extracorporeal membrane oxygenation (ECMO) has replaced cardiopulmonary bypass (CPB) for cardiopulmonary support during lung transplantation at our institution. In this study, we present our experience using intraoperative ECMO in isolated lung transplantation and evaluate its impact on long-term graft function and survival. METHODS: All patients undergoing isolated lung transplantation with or without ECMO support between January 2010 and June 2019 were evaluated. Patients transplanted using CPB were excluded. Peri-operative and follow-up results from our database and patient charts were analyzed. Follow-up continued until September 1, 2019 (median, 3.34 years). RESULTS: In total, 311 of 1,161 lung transplant recipients (27%) received intraoperative ECMO, with 24 (2%) patients further requiring CPB. None of the remaining 826 (71%) patients required intraoperative cardiopulmonary support. ECMO patients exhibited higher pre-transplant surgical risk profiles and endured more complicated early post-operative courses than those without ECMO (in-hospital mortality, 10.9% vs 2.3%; p < 0.001). Inevitably, this resulted in poorer overall graft survival among ECMO recipients (p = 0.0025). However, correcting for patients surviving to hospital discharge, no difference in survival between groups was observed (5-year survival, 71% vs 72%; p = 0.56). Similarly, freedom from chronic lung allograft dysfunction, biopsy-confirmed cellular rejection, or need for pulsed-steroid therapy did not differ between the groups (p = 0.99, p = 0.78, and p = 0.93, respectively). CONCLUSIONS: Compared with patients not requiring cardiopulmonary support, ECMO recipients endured a more complicated peri-operative and early post-operative course. However, among those surviving to hospital discharge, no differences in long-term complications or outcomes were observed.
INTRODUCTION: Over the past decade, extracorporeal membrane oxygenation (ECMO) has replaced cardiopulmonary bypass (CPB) for cardiopulmonary support during lung transplantation at our institution. In this study, we present our experience using intraoperative ECMO in isolated lung transplantation and evaluate its impact on long-term graft function and survival. METHODS: All patients undergoing isolated lung transplantation with or without ECMO support between January 2010 and June 2019 were evaluated. Patients transplanted using CPB were excluded. Peri-operative and follow-up results from our database and patient charts were analyzed. Follow-up continued until September 1, 2019 (median, 3.34 years). RESULTS: In total, 311 of 1,161 lung transplant recipients (27%) received intraoperative ECMO, with 24 (2%) patients further requiring CPB. None of the remaining 826 (71%) patients required intraoperative cardiopulmonary support. ECMO patients exhibited higher pre-transplant surgical risk profiles and endured more complicated early post-operative courses than those without ECMO (in-hospital mortality, 10.9% vs 2.3%; p < 0.001). Inevitably, this resulted in poorer overall graft survival among ECMO recipients (p = 0.0025). However, correcting for patients surviving to hospital discharge, no difference in survival between groups was observed (5-year survival, 71% vs 72%; p = 0.56). Similarly, freedom from chronic lung allograft dysfunction, biopsy-confirmed cellular rejection, or need for pulsed-steroid therapy did not differ between the groups (p = 0.99, p = 0.78, and p = 0.93, respectively). CONCLUSIONS: Compared with patients not requiring cardiopulmonary support, ECMO recipients endured a more complicated peri-operative and early post-operative course. However, among those surviving to hospital discharge, no differences in long-term complications or outcomes were observed.
Authors: Robert Greite; Johanna Störmer; Faikah Gueler; Rasul Khalikov; Axel Haverich; Christian Kühn; Nodir Madrahimov; Ruslan Natanov Journal: Int J Mol Sci Date: 2022-09-20 Impact factor: 6.208
Authors: Jens Gottlieb; Geert M Verleden; Michael Perchl; Christina Valtin; Alexander Vallee; Olivier Brugière; Carlos Bravo Journal: PLoS One Date: 2021-12-23 Impact factor: 3.240