Intraoperative Extracorporeal Circulatory Support in Lung Transplantation for Pulmonary Fibrosis

Salman, J.; Bernhard, Beeke-Alina; Ius, F.; Poyanmehr, Reza; Sommer, W.; Aburahma, K.; Alhadidi, Hani; Siemeni, T.; Kuehn, C.; Avşar, M.; Haverich, Axel; Warnecke, G.; Tudorache, I.

doi:10.1016/j.athoracsur.2020.06.083

Cited by 9 publications

(6 citation statements)

References 23 publications

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“…Extracorporeal membrane oxygenation (ECMO) is increasingly used in the context of thoracic organ transplantation [ 1 , 2 , 3 ]. Veno venous (vv) ECMO is applied in severe respiratory failure refractory to intense mechanical ventilation and provides extracorporeal lung support and veno arterial (va) ECMO is used for cardiac support [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Different Acute Kidney Injury Patterns after Renal Ischemia Reperfusion Injury and Extracorporeal Membrane Oxygenation in Mice

Greite

Störmer

Gueler

et al. 2022

IJMS

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The use of extracorporeal membrane oxygenation (ECMO) is associated with acute kidney injury (AKI) in thoracic organ transplantation. However, multiple other factors contribute to AKI development after these procedures such as renal ischemia-reperfusion injury (IRI) due to hypo-perfusion of the kidney during surgery. In this study, we aimed to explore the kidney injury patterns in mouse models of ECMO and renal IRI. Kidneys of C57BL/6 mice were examined after moderate (35 min) and severe (45 min) unilateral transient renal pedicle clamping and 2 h of veno-venous ECMO. Renal injury markers, neutrophil infiltration, tubular transport function, pro-inflammatory cytokines, and renal heme oxygenase-1 (HO-1) expression were determined by immunofluorescence and qPCR. Both procedures caused AKI, but with different injury patterns. Severe neutrophil infiltration of the kidney was evident after renal IRI, but not following ECMO. Tubular transport function was severely impaired after renal IRI, but preserved in the ECMO group. Both procedures caused upregulation of pro-inflammatory cytokines in the renal tissue, but with different time kinetics. After ECMO, but not IRI, HO-1 was strongly induced in tubular cells indicating contact with hemolysis-derived proteins. After IRI, HO-1 was expressed on infiltrating myeloid cells in the tubulo-interstitial space. In conclusion, renal IRI and ECMO both caused AKI, but kidney damage after renal IRI was more pronounced including severe neutrophil infiltration and tubular transport impairment. Enhanced HO-1 expression in tubular cells after ECMO encourages limitation of hemolysis as a therapeutic approach to reduce ECMO-associated AKI.

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Section: Introductionmentioning

confidence: 99%

Different Acute Kidney Injury Patterns after Renal Ischemia Reperfusion Injury and Extracorporeal Membrane Oxygenation in Mice

Greite

Störmer

Gueler

et al. 2022

IJMS

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“…The indication for intraoperative cardiopulmonary support is usually confirmed on test clamping of the pulmonary artery before pneumectomy and implantation of the donor lung as well as after test clamping of the contralateral pulmonary artery for implantation of the second side. 6 Criteria of ECMO support followed the national guidelines and were reported elsewhere. 13 Retrospectively collected data included routine pretransplant variables, primary diagnoses indicating LT, duration of extracorporeal circulatory support during and after transplantation, as well as the length of stay in the intensive care unit and long-term survival outcome.…”

Section: Methodsmentioning

confidence: 99%

“… 5 High pulmonary vascular resistance also elevated risk to require intraoperative extracorporeal support because of the risk of right heart failure as well as reduced oxygenation capacities in patients in critical condition. 6 …”

mentioning

confidence: 99%

Association of Pulmonary Artery Pressure Change With Post-Lung Transplantation Survival

Jiao

Huang

et al. 2022

JACC: Asia

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“…Many lung transplants centers face a current problem: the scarcity of donors and the fact that patients with significantly more comorbidities and with advanced ages for LTx are listed, which happens very often with patients with pulmonary fibrosis (60). It becomes crucial to minimize perioperative complications and improve the outcomes.…”

Section: Expanding the Indication For Intraoperative Support -Prophylactic Va Ecmomentioning

confidence: 99%

Intraoperative support during lung transplantation

Santos¹,

D’Cunha²

2021

J Thorac Dis

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The role of intraoperative mechanical support during lung transplantation (LTx) is essential to provide a safe hemodynamic and ventilatory status during critical intraoperative events. This hemodynamic and ventilatory stability is vital to minimize the odds of suboptimal outcomes, especially considering that, due to the scarcity of donors and the fact that more and more patients with significant comorbidities are being considered for this therapy, a more aggressive approach is often needed by the transplant centers.Hence, the attenuation of any potential injury that can happen during this complex event is paramount.While a thorough assessment of the donor and optimization of postoperative care is pursued, certainly protective intraoperative management would also contribute to better outcomes. Understanding each patient's underlying anatomy and cardiopulmonary physiology, associated with awareness of critical events during a complicated procedure like LTx, is essential for a precise indication and safe use of support.Cardiopulmonary bypass (CPB) and veno-arterial extracorporeal membrane oxygenation (VA ECMO) have been the most common approaches used, with the latter gaining popularity more recently and we have used VA ECMO exclusively for the last decade. New technologies certainly contributed to more liberal use of VA ECMO intraoperatively, enabling a protecting and physiologic environment for the newly implanted grafts.In this setting, potential prophylactic use for lung protection during a critical period is also considered.

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Intraoperative Extracorporeal Circulatory Support in Lung Transplantation for Pulmonary Fibrosis

Cited by 9 publications

References 23 publications

Different Acute Kidney Injury Patterns after Renal Ischemia Reperfusion Injury and Extracorporeal Membrane Oxygenation in Mice

Different Acute Kidney Injury Patterns after Renal Ischemia Reperfusion Injury and Extracorporeal Membrane Oxygenation in Mice

Association of Pulmonary Artery Pressure Change With Post-Lung Transplantation Survival

Intraoperative support during lung transplantation

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