Ambulatory Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation

Lehr, Carli J.; Zaas, David; Cheifetz, Ira M.; Turner, David A.

doi:10.1378/chest.14-2188

Cited by 90 publications

(80 citation statements)

References 42 publications

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“…By understanding and anticipating the mortality after transplantation associated with advanced age, renal failure, long ischemic times, and CMV mismatch, centers may better select patients for bridging, further mitigate the mortality burden, and enhance the selection process as to who should be bridged and how (MV vs ECMO (21)(22)(23)(24)). There is likely to remain a growing interest in the use of ambulatory ECMO, without the use of MV, to avoid sedation and immobilization and prevent collateral morbidity from multisystem organ failure that has plagued traditional ECMO in the past (25,26).…”

Section: Discussionmentioning

confidence: 99%

Mechanical Ventilation and Extracorporeal Membrane Oxygenation as a Bridging Strategy to Lung Transplantation: Significant Gains in Survival

Hayanga

Joubert

et al. 2018

American Journal of Transplantation

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Mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) are increasingly used to bridge patients to lung transplantation. We investigated the impact of using MV, with or without ECMO, before lung transplantation on survival after transplantation by performing a retrospective analysis of 826 patients who underwent transplantation at our high-volume center. Recipient characteristics and posttransplant outcomes were analyzed. Most lung transplant recipients (729 patients) did not require bridging; 194 of these patients were propensity matched with patients who were bridged using MV alone (48 patients) or MV and ECMO (49 patients). There was no difference in overall survival between the MV and MV+ECMO groups (p = 0.07). The MV+ECMO group had significantly higher survival conditioned on surviving to 1 year (median 1,811 days ([MV] vs. not reached ([MV+ECMO], p = 0.01). Recipients in the MV+ECMO group, however, were more likely to require ECMO after lung transplantation (16.7% MV vs. 57.1% MV+ECMO, p < 0.001). There were no differences in duration of postoperative MV, hospital stay, graft survival, or the incidence of acute rejection, renal failure, bleeding requiring reoperation, or airway complications. In this contemporary series, the combination of MV and ECMO was a viable bridging strategy to lung transplantation that led to acceptable patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Mechanical Ventilation and Extracorporeal Membrane Oxygenation as a Bridging Strategy to Lung Transplantation: Significant Gains in Survival

Hayanga

Joubert

et al. 2018

American Journal of Transplantation

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“…Since the introduction of LAS, the proportion of patients transplanted while on ECLS has increased, both in the US and in ET [13]. Although this is an unwanted effect of an allocation scheme without waiting time, several centres report good outcome for their awake ECLS patients due to expertise and quick access to transplantation [14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Lung allocation score: the Eurotransplant model versus the revised US model - a cross-sectional study

et al. 2018

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Both Eurotransplant (ET) and the US use the lung allocation score (LAS) to allocate donor lungs. In 2015, the US implemented a new algorithm for calculating the score while ET has fine-tuned the original model using business rules. A comparison of both models in a contemporary patient cohort was performed. The rank positions and the correlation between both scores were calculated for all patients on the active waiting list in ET. On February 6th 2017, 581 patients were actively listed on the lung transplant waiting list. The median LAS values were 32.56 and 32.70 in ET and the US, respectively. The overall correlation coefficient between both scores was 0.71. Forty-three per cent of the patients had a < 2 point change in their LAS. US LAS was more than two points lower for 41% and more than two points higher for 16% of the patients. Median ranks and the 90th percentiles for all diagnosis groups did not differ between both scores. Implementing the 2015 US LAS model would not significantly alter the current waiting list in ET.

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“…However three and five year posttransplant survival was significantly lower in the septuagenarian group [13], indicating that lung transplants in patients of advanced age require more scrutiny and further research. Also increasing the demand for donor lungs are the rising number of patients bridged with mechanical ventilation or extracorporeal membranous oxygenation (ECMO), allowing the evaluation and waitlisting of patients previously too ill to wait for a lung transplant [14]. Finally, a new frontier in expanding patient access to lung transplant is the transplantation of patients with HIV [15].…”

Section: Ways To Improve Access To Lung Transplantmentioning

confidence: 99%

Contemporary Issues in Lung Transplant Allocation Practices

Tsuang

2017

Curr Transpl Rep

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Purpose of Review To discuss the current state of donor lung allocation in the United States, and future opportunities to increase the efficiency of donor lung allocation. Recent Findings The current donor lung allocation system prioritizes clinical acuity by use of the Lung Allocation Score (LAS) which has reduced waitlist mortality since its implementation in 2005. Access to donor lungs can be further improved through policy changes using broader geographic sharing, and developing new technology such as ex vivo lung perfusion to recover marginal donor lungs. Summary The number of lung transplants in the U.S. continues to increase annually. However, the demand for donor lungs continues to be outpaced by an ever growing waitlist. Efficient allocation can be achieved through improved allocation policies and new technology.

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Ambulatory Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation

Cited by 90 publications

References 42 publications

Mechanical Ventilation and Extracorporeal Membrane Oxygenation as a Bridging Strategy to Lung Transplantation: Significant Gains in Survival

Mechanical Ventilation and Extracorporeal Membrane Oxygenation as a Bridging Strategy to Lung Transplantation: Significant Gains in Survival

Lung allocation score: the Eurotransplant model versus the revised US model - a cross-sectional study

Contemporary Issues in Lung Transplant Allocation Practices

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