Intraoperative extracorporeal membrane oxygenation and the possibility of postoperative prolongation improve survival in bilateral lung transplantation

Höetzenecker, Konrad; Schwarz, Štefan; Muckenhuber, Moritz; Benazzo, Alberto; Frommlet, Florian; Schweiger, Thomas; Bata, Orsolya; Jaksch, Péter; Ahmadi, Negar; Muraközy, G.; Prosch, Helmut; Hager, Helmut; Roth, Georg A.; Láng, György; Taghavi, Shahrokh; Klepetko, Walter

doi:10.1016/j.jtcvs.2017.10.144

Cited by 197 publications

(197 citation statements)

References 39 publications

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“…The Munich lung group also published their experience with intraoperative ECMO application, they reported a perioperative mortality of 11.1% and a 1-year survival of 81.5% in the ECMO group and 4.5, and 81.8% in the non- ECMO group [9]. The Vienna group summarized their experiences of intraoperative ECMO implementation in bilateral lung transplantation between 2010 and 2016, and reported a 1-year survival rate of 91% in the ECMO group 82% in the non-ECMO group [22]. Ko et al demonstrate the survival rate in single lung transplantation undergoing ECMO was 66.7% [23].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation

Zhang

Sang

et al. 2020

Respir Res

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Background: Intraoperative Extracorporeal membrane oxygenation (ECMO) is increasingly being applied as lifesupport for lung transplantation patients. However, factors associated with this procedure in lung transplantation patients have not yet been characterized. The aim of this study was to identify preoperative factors of intraoperative ECMO support during lung transplantation and to evaluated the outcome of lung transplantation patients supported with ECMO. Methods: Patients underwent lung transplantation treated with and without ECMO in Guangzhou Institute of Respiratory Diseases between January 2015 to August 2018 were retrospectively reviewed. Patient demographics and clinical variables were collected and analyzed. Multivariate logistic regression was performed to identify factors independently associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation. Results: During the study period, 138 patients underwent lung transplantation at our institution, the mean LAS was (56.63 ± 18.39) (range, 32.79 to 88.70). Fourty four patients were treated with veno-venous/veno-arterial ECMO. Among the patients, 32 patients wean successfully ECMO after operation, 12 patients remain ECMO after operation, and 32 patients (62.74%) survived to hospital discharge. In multiple analysis, the following factors were associated with intraoperative ECMO support: advanced age, high PAP before operation, duration of mechanical ventilation before operation, a higher APACHE II and primary diagnosis for transplantation. The overall survival rates at 1, 3, and 12 months were 90. 91, 72.73, and 56.81% in the ECMO group, and 95.40, 82.76, and 73.56% in the non-ECMO group, respectively (log-rank P = 0.081). Patients who underwent single lung transplant had a lower survival rates in ECMO group as compared with non-ECMO group at 1, 3, and 12 months (90.47% vs 98.25, 71.43% vs 84.21, and 52.38% vs 75.44%) (log-rank P = 0.048). Conclusions: The preoperative factors of intraoperative ECMO support during lung transplantation included age, high PAP before operation, preoperative mechanical ventilation, a higher APACHE II and primary diagnosis for transplantation based on multivariate analysis.

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Section: Discussionmentioning

confidence: 99%

Factors associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation

Zhang

Sang

et al. 2020

Respir Res

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“…Most of the patients had cystic fibrosis as an underlying diagnosis, and 2 (12.5%) patients were transplanted for sarcoidosis, 2 (12.5%) for extrinsic allergic alveolitis, and 1 (6.3%) for scleroderma. In 5 patients, VA-ECMO was prolonged in the postoperative period according to our institutional preventive strategy for primary graft dysfunction (PGD) [14, 15]. Twelve (75%) patients had PGD grade 0 at 72 h, 1 patient had PGD grade 1, and 3 patients had ungradable PGD.…”

Section: Resultsmentioning

confidence: 99%

Outcome of Extracorporeal Photopheresis as an Add-On Therapy for Antibody-Mediated Rejection in Lung Transplant Recipients

Benazzo

Worel

Schwarz

et al. 2020

Transfus Med Hemother

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Introduction: The diagnosis and treatment of antibody-mediated rejection (AMR) after lung transplantation has recently gained recognition within the transplant community. Extracorporeal photopheresis (ECP), currently used to treat chronic lung allograft dysfunction, modulates various pathways of the immune system known to be involved in AMR. We hypothesize that adding ECP to established AMR treatments could prevent the rebound of donor-specific antibodies (DSA). Objectives: This study aimed to analyze the role of ECP as an add-on therapy to prevent the rebound of DSA. Methods: Lung transplant recipients who received ECP as an add-on therapy for pulmonary AMR between January 2010 and January 2019 were included in this single-center retrospective analysis. Baseline demographics of the patients, as well as their immunological characteristics and long-term transplant outcomes, were analyzed. Results: A total of 41 patients developed clinical AMR during the study period. Sixteen patients received ECP as an add-on therapy after first-line AMR treatment. Among the 16 patients, 2 (13%) had pretransplant DSA, both against human leukocyte antigen (HLA) class I (B38, B13, and C06). Fifteen patients (94%) developed de novo DSA (dnDSA), i.e., 10 (63%) against class I and 14 (88%) against class II. The median time to dnDSA after lung transplantation was 361 days (range 25–2,548). According to the most recent International Society of Heart and Lung Transplantation (ISHLT) consensus report, 2 (13%) patients had definite clinical AMR, 6 (38%) had probable AMR, and 7 (44%) had possible AMR. The median mean fluorescence intensity (MFI) of dnDSA at the time of clinical diagnosis was 4,220 (range 1,319–10,552) for anti-HLA class I and 10,953 (range 1,969–27,501) for anti-HLA class II antibodies. ECP was performed for a median of 14 cycles (range 1–64). MFI values of dnDSA against HLA classes I and II were significantly reduced over the treatment period (for anti-class I: 752; range 70–2,066; for anti-class II: 5,612; range 1,689–21,858). The 1-year survival rate was 55%. No adverse events related to ECP were reported in any of the patients. Conclusions: ECP is associated with a reduction of dnDSA in lung transplant recipients affected by AMR. Prospective studies are warranted to confirm the beneficial effects of ECP in the setting of AMR.

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“…At our center, postoperative ECMO is used to reduce transpulmonary blood flow to prevent volume overflow to the newly implanted lungs in patients with pulmonary hypertension. Despite the increased risk of postoperative bleeding associated with postoperative ECMO, our group has recently shown that intraoperative ECMO support and prophylactic ECMO prolongation into the early postoperative period result in superior outcomes in recipients with pulmonary hypertension or questionable graft function compared to recipients without ECMO support .…”

Section: Discussionmentioning

confidence: 99%

“…All transplants were performed as bilateral sequential transplants, with or without the use of intraoperative ECMO. Our ECMO protocol was reported recently . For intraoperative use, central cannulation was performed using heparin‐coated tubing (Medtronic Carmeda BioActive Surface; Medtronic Inc., Minneapolis, MN, USA).…”

Section: Methodsmentioning

confidence: 99%

Risk factors for early bleeding complications after lung transplantation – a retrospective cohort study

et al. 2019

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Risk factors for early bleeding complications after lung transplantation are not well described. Our aim was to evaluate coagulation test results and the use of extracorporeal membrane oxygenation as risk factors for bleeding after lung transplantation. We analyzed a single-center cohort of bilateral lung transplants between January 2009 and August 2015. Predictors of severe postoperative bleeding (bleeding requiring reoperation within 48 h of transplantation) were assessed using multivariable logistic regression. The effect of bleeding on survival was assessed using a Cox proportionalhazards model. Twenty-nine (4.5%) of 641 patients experienced severe postoperative bleeding. Postoperative fibrinogen levels (OR = 0.99, 95% CI 0.98-0.995, P = 0.001; per mg/dl increase) and pre-and postoperative use of extracorporeal membrane oxygenation (OR = 14.41% 95% CI 5.4-40.19, P < 0.001 and OR = 4.25, 95% CI 1.0-11.09, P = 0.002, respectively) were associated with an increased risk of severe postoperative bleeding. Severe postoperative bleeding was associated with decreased survival within 60 days after transplantation (adjusted HR = 5.73, 95% CI 2.52-13.02, P < 0.001). Low postoperative fibrinogen levels, and pre-and postoperative use of extracorporeal membrane oxygenation were risk factors for bleeding after lung transplantation.

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Intraoperative extracorporeal membrane oxygenation and the possibility of postoperative prolongation improve survival in bilateral lung transplantation

Cited by 197 publications

References 39 publications

Factors associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation

Factors associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation

Outcome of Extracorporeal Photopheresis as an Add-On Therapy for Antibody-Mediated Rejection in Lung Transplant Recipients

Risk factors for early bleeding complications after lung transplantation – a retrospective cohort study

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