Lung Transplantation for Ventilator-Dependent Respiratory Failure

Vermeijden, Wytze J.; Zijlstra, Jan G.; Erasmus, Michiel E.; Bij, Wim van der; Verschuuren, Erik

doi:10.1016/j.healun.2009.01.012

Cited by 34 publications

(17 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Critical illness dramatically decreases the likelihood of successful lung transplantation, 4,7,28 such that support with mechanical ventilation and/or ECMO are relative contraindications to lung transplantation in some centers. 29 Despite the severity of critical illness in the subjects included in this study, 1 year post-transplant survival was 100%, demonstrating that bridging subjects to lung transplantation with ECMO may be a viable option for selected critically ill patients with end-stage lung disease.…”

Section: Discussionmentioning

confidence: 99%

Active Rehabilitation During Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation

Rehder

Turner

Hartwig³

et al. 2012

Respir Care

176

162

View full text Add to dashboard Cite

Background Patients with end-stage lung disease often progress to critical illness, which dramatically reduces their chance of survival following lung transplantation. Pre-transplant deconditioning has a significant impact on outcomes for all lung transplant patients, and is likely a major contributor to increased mortality in critically ill lung transplant recipients. The aim of this report is to describe a series of patients bridged to lung transplant with extracorporeal membrane oxygenation (ECMO) and to examine the potential impact of active rehabilitation and ambulation during pre-transplant ECMO. Methods This retrospective case series reviews all patients bridged to lung transplantation with ECMO at a single tertiary care lung transplant center. Pre-transplant ECMO patients receiving active rehabilitation and ambulation were compared to those patients who were bridged with ECMO but did not receive pre-transplant rehabilitation. Results Nine consecutive subjects between April 2007 and May 2012 were identified for inclusion. One-year survival for all subjects was 100%, with one subject alive at 4 months post-transplant. The 5 subjects participating in pre-transplant rehabilitation had shorter mean post-transplant mechanical ventilation (4 d vs 34 d, P = .01), ICU stay (11 d vs 45 d, P = .01), and hospital stay (26 d vs 80 d, P = .01). No subject who participated in active rehabilitation had post-transplant myopathy, compared to 3 of 4 subjects who did not participate in pre-transplant rehabilitation on ECMO. Conclusions Bridging selected critically ill patients to transplant with ECMO is a viable treatment option, and active participation in physical therapy, including ambulation, may provide a more rapid post-transplantation recovery. This innovative strategy requires further study to fully evaluate potential benefits and risks.

show abstract

Section: Discussionmentioning

confidence: 99%

Active Rehabilitation During Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation

Rehder

Turner

Hartwig³

et al. 2012

Respir Care

176

162

View full text Add to dashboard Cite

show abstract

“…Although several studies suggest patients can be successfully bridged to LTx with mechanical support, most of these single institutional studies suffer from relatively small sample size. [3,4] Additionally, no previous studies have evaluated the temporal trends in the outcomes of these highest acuity recipients. We undertook this study to understand the impact of recipient acuity on outcomes after LTx, with special emphasis on temporal trends in 1-year survival.…”

Section: Introductionmentioning

confidence: 99%

Outcomes and temporal trends among high-risk patients after lung transplantation in the United States

George¹,

Beaty²,

Kilic³

et al. 2012

The Journal of Heart and Lung Transplantation

View full text Add to dashboard Cite

Introduction: Although several studies have evaluated risk factors for mortality after lung transplantation (LTx), few studies have focused on the highest risk recipients. We undertook this study to evaluate the impact of high lung allocation scores (LAS), ventilator support, and extracorporeal membrane oxygenation (ECMO) support on outcomes after LTx. Methods: We retrospectively reviewed all LTx recipients in the United Network for Organ Sharing database. Primary stratification was by recipient acuity at the time of LTx. The three strata consisted of: (1) recipients in the highest LAS quartile (LAS≥48.4); (2) those requiring ventilator support; and (3) those requiring ECMO support. The primary outcome was 1-year mortality. Subgroup analysis focused on temporal trends. Results: From 05/2005-06/2011, 9,267 adult patients underwent LTx. Prior to LTx, 1,874 (20.2%) were in the highest LAS quartile, 526 (5.7%) required ventilator support, and 122 (1.3%) required ECMO support. On unadjusted analysis, ventilator and ECMO support were both associated with decreased 1-year survival compared to those in the highest LAS quartile (High LAS: 81.0% vs. Vent: 67.7% vs. ECMO: 57.6%, p<0.001 for each comparison). These differences persisted on adjusted analysis (Ventilator support, HR: 1.99, p<0.001; ECMO support, HR: 3.03, p<0.001). Increasing annual center volume was associated with decreased mortality. In patients bridged to LTx with ECMO support, 1-year survival improved over time (Coefficient: 8.03%/year, p=0.06). Conclusions: High acuity LTx recipients, particularly those bridged with ventilator or ECMO support, have increased short-term mortality after LTx. However, since the introduction of the LAS, high-risk patients have demonstrated improving outcomes, particularly at high volume centers.

show abstract

“…7 In contrast, in ET, with its urgency-tier system, ventilated patients were transplanted successfully during the past 15 years and its proportion is Ͼ10% in some centers. 8,9 With these restrictions in mind a new benefit score based on the LAS was proposed, called the LASplus.…”

mentioning

confidence: 99%

Evaluation of the lung allocation score in highly urgent and urgent lung transplant candidates in Eurotransplant

Smits

Nossent

Vries

et al. 2011

The Journal of Heart and Lung Transplantation

View full text Add to dashboard Cite

Lung Transplantation for Ventilator-Dependent Respiratory Failure

Cited by 34 publications

References 21 publications

Active Rehabilitation During Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation

Active Rehabilitation During Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation

Outcomes and temporal trends among high-risk patients after lung transplantation in the United States

Evaluation of the lung allocation score in highly urgent and urgent lung transplant candidates in Eurotransplant

Contact Info

Product

Resources

About