Extracorporeal membrane oxygenation as a bridge to lung transplantation: A single-center experience in the present era

Todd, E.; Roy, Sreeja Biswas; Hashimi, A. Samad; Serrone, Rosemarie; Panchanathan, Roshan; Kang, Paul; Varsch, Katherine E.; Steinbock, Barry E.; Huang, Jasmine; Omar, Ashraf; Patel, Vipul; Walia, Rajat; Smith, Michael A.; Bremner, Ross M.

doi:10.1016/j.jtcvs.2017.06.063

Cited by 64 publications

(48 citation statements)

References 34 publications

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“…Our results underline previously published series showing that ECLS bridging to LTx results in good overall outcomes in experienced centers. 12,13 However, given the complexity of these patients, intention-to-treat survival is generally lower compared with transplantation without bridging. 14,15 Most of these very sick patients would die awaiting their transplant without ECLS.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal life support as a bridge to lung transplantation–experience of a high-volume transplant center

Höetzenecker

Donahoe

Yeung

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

134

105

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Section: Discussionmentioning

confidence: 99%

Extracorporeal life support as a bridge to lung transplantation–experience of a high-volume transplant center

Höetzenecker

Donahoe

Yeung

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

134

105

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“…ECMO has the possibility of minimising the risk of "triggering" underlying chronic processes that can lead to fatal deterioration of the lungs by providing extracorporeal lung support, which can allow one to reduce the invasiveness of ventilation. ECMO may also bridge the period necessary for registering selected patients for a lung transplant [26,75,76].…”

Section: Management Of Aementioning

confidence: 99%

Acute exacerbations of progressive-fibrosing interstitial lung diseases

et al. 2018

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Acute exacerbation of interstitial lung disease (ILD) is associated with a poor prognosis and high mortality. Numerous studies have documented acute exacerbation in idiopathic pulmonary fibrosis (IPF), but less is known about these events in other ILDs that may present a progressive-fibrosing phenotype. We propose defining acute exacerbation as an acute, clinically significant respiratory deterioration, typically less than 1 month in duration, together with computerised tomography imaging showing new bilateral glass opacity and/or consolidation superimposed on a background pattern consistent with fibrosing ILDs. Drawing on observations in IPF, it is suspected that epithelial injury or proliferation and autoimmunity are risk factors for acute exacerbation in ILDs that may present a progressive-fibrosing phenotype, but further studies are required. Current acute exacerbation management strategies are based on recommendations in IPF, but no randomised controlled trials of acute exacerbation management have been performed. Although there are no formal strategies to prevent the development of acute exacerbation, possible approaches include antifibrotic drugs (such as nintedanib and pirfenidone), and minimising exposure to infection, airborne irritants and pollutants. This review discusses the current knowledge of acute exacerbation of ILDs that may present a progressive-fibrosing phenotype and acknowledges limitations of the data available.

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“…The introduction of the LAS has resulted in more patients undergoing transplant for IPF and other ILDs [ 2 ], and the use of extracorporeal membrane oxygenation support for patients in respiratory failure expands the window during which patients with acute or chronic lung failure may undergo transplant [ 13 ]. Because of the LAS, lungs are preferentially allocated to those with a higher chance of imminent death while on the waitlist.…”

Section: Discussionmentioning

confidence: 99%

Incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare-up: A clinical dilemma

Patil

Sultan

Hahn

et al. 2018

Respiratory Medicine Case Reports

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Patients under consideration for lung transplantation as treatment for end-stage lung diseases such as idiopathic pulmonary fibrosis (IPF) often have risk factors such as a history of smoking or concomitant emphysema, both of which can predispose the patient to lung cancer. In fact, IPF itself increases the risk of lung cancer development by 6.8% to 20%. Solid organ malignancy (non-skin) is an established contraindication for lung transplantation. We encountered a clinical dilemma in a patient who presented with an IPF flare-up and underwent urgent evaluation for lung transplantation. After transplant, the patient's explanted lungs showed extensive adenocarcinoma in situ, with the foci of invasion and metastatic adenocarcinoma in N1-level lymph nodes, as well as usual interstitial pneumonia. Retrospectively, we saw no evidence to suggest malignancy in addition to the IPF flare-up. Clinical diagnostic dilemmas such as this emphasize the need for new noninvasive testing that would facilitate malignancy diagnosis in patients too sick to undergo invasive tissue biopsy for diagnosis. Careful pathological examination of explanted lungs in patients with IPF is critical, as it can majorly influence immunosuppressive regimens, surveillance imaging, and overall prognosis after lung transplant.

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Extracorporeal membrane oxygenation as a bridge to lung transplantation: A single-center experience in the present era

Abstract: Extracorporeal membrane oxygenation can be used to safely bridge high-acuity patients with end-stage lung disease to lung transplantation with good 30-day, 90-day, and 1-year survival and excellent 1-year functional status. Long-term outcomes are being studied.

Cited by 64 publications

References 34 publications

Extracorporeal life support as a bridge to lung transplantation–experience of a high-volume transplant center

Extracorporeal life support as a bridge to lung transplantation–experience of a high-volume transplant center

Acute exacerbations of progressive-fibrosing interstitial lung diseases

Incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare-up: A clinical dilemma

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