Early institution of extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation improves outcome. J Heart Lung Transplant 2007 Apr;26(4):331-8
Date
04/04/2007Pubmed ID
17403473DOI
10.1016/j.healun.2006.12.010Scopus ID
2-s2.0-33947659530 (requires institutional sign-in at Scopus site) 92 CitationsAbstract
BACKGROUND: Primary graft dysfunction (PGD) after lung transplantation (LTx) carries a significant mortality and clinical management is controversial. Extracorporeal membrane oxygenation (ECMO) has been used infrequently for recovery from acute lung injury (ALI) in this setting. We reviewed our experience with ECMO after primary LTx.
METHODS: The present study is a retrospective analysis of all LTx patients between 1991 and 2004. Twenty-two patients sustained severe PGD with subsequent placement on ECMO. We analyzed indications and 30-day, 1-year and 3-year mortality. Complications and incidence of multiple-organ failure (MOF) were determined. Critical appraisal of the evidence available to date was performed.
RESULTS: A total of 297 LTxs were performed during the study period, with 97.5%, 88.6% and 73.8% survival at 30 days, 1 year and 3 years, respectively. Twenty-two patients (7.9%) had severe allograft dysfunction leading to ECMO support. Twelve patients received single-lung (SLTx), 8 double-lung (BLTx), 1 single-lung/kidney (SLKTx) and 1 heart/lung (HLTx) transplantation. Thirty-day, 1-year and 3-year survival of LTx recipients with ECMO support post-operatively were 74.6%, 54% and 36%, respectively. MOF was the predominant cause of death (58.3%) in patients on ECMO support for PGD.
CONCLUSIONS: Our data suggest that, in addition to prolonged ventilation and pharmacologic support, ECMO should be considered as a bridge to recovery from PGD in lung transplantation. Early institution of ECMO may lead to diminished mortality in the setting of ALI despite the high incidence of MOF. Late institution of ECMO was associated with 100% mortality in this investigation.
Author List
Wigfield CH, Lindsey JD, Steffens TG, Edwards NM, Love RBMESH terms used to index this publication - Major topics in bold
AdultAged
Extracorporeal Membrane Oxygenation
Female
Heart-Lung Transplantation
Humans
Incidence
Kaplan-Meier Estimate
Kidney Transplantation
Lung Diseases
Lung Transplantation
Male
Middle Aged
Multiple Organ Failure
Retrospective Studies
Time Factors
Treatment Outcome