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Long-term outcomes after intraoperative extracorporeal membrane oxygenation during lung transplantation.

Authors
  • Ius, Fabio1
  • Aburahma, Khalil2
  • Boethig, Dietmar2
  • Salman, Jawad2
  • Sommer, Wiebke3
  • Draeger, Helge2
  • Poyanmehr, Reza2
  • Avsar, Murat2
  • Siemeni, Thierry2
  • Bobylev, Dmitry2
  • Optenhoefel, Joerg2
  • Wiesner, Olaf4
  • Greer, Mark4
  • Schwerk, Nicolaus5
  • Hoeper, Marius M6
  • Welte, Tobias6
  • Haverich, Axel3
  • Kuehn, Christian2
  • Warnecke, Gregor3
  • Gottlieb, Jens6
  • And 1 more
  • 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany. Electronic address: [email protected] , (Germany)
  • 2 Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany. , (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. , (Germany)
  • 4 Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany. , (Germany)
  • 5 Department of Paediatrics, Hannover Medical School, Hannover, Germany. , (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. , (Germany)
Type
Published Article
Journal
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Publication Date
Sep 01, 2020
Volume
39
Issue
9
Pages
915–925
Identifiers
DOI: 10.1016/j.healun.2020.04.020
PMID: 32444157
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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). 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). 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. Copyright © 2020 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

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